The views expressed here reflect the views of
the authors alone, and do not necessarily reflect the views of any
of their organizations. In particular, the views expressed here do
not necessarily reflect those of Big Medicine, nor any member of
Team EMS Inc.

The latest in a countless series of grave warnings sent by email with an
ever-changing list of signatories, this one was supposedly from a PhD MD RN
MSc and opened with this phrase:

"No
one should take the swine flu vaccine-it is one of the most dangerous
vaccines ever devised"

In the absence of
intense myth-busting information communicated by credible leaders, this
kind of crapola propagates. Several times a day I find myself being
called upon to explain why I believe it’s essential that we all get
vax’d against H1.

Here's my response:

For me, it has
become a very serious risk v benefit model.

And understand, Di
and I sweat each and every time we get the kids inoculated against
something. We wonder – just a little bit – about the safety of the vax.
There’s that moment of dread that lasts from the time the needle breaks
skin to the time it takes for us to be convinced of no evil and
debilitating sequelae.

And then there’s H1N1.

There’s nothing abstract about this – it’s not like the concept that I
might be hit by a truck. Might. Maybe. Likely never happen.

H1N1 is a real threat. It has replaced the seasonal flu virus as the
dominant flu bug crisscrossing the globe. Just think about that fact for
a moment. Wow. H1N1 is the king of the microbe heap and it’s only been
in circulation since April.

H1N1 has a disproportionately awful impact on the very young, on
pregnant women, and on people with underlying medical conditions. How
many asthmatic kids do you know? My own daughter is still prone to croup
at age 11 – when she was younger she weathered some critical moments in
ERs and ambulances. How many young people are medically fragile? How
many adults are medically fragile? The answer will blow you away when
you realize just how high the percentage of the population are
considered at risk.

From the CDC briefing on Oct 16

“There are now a total of 86 children under 18 who died from this H1N1
influenza virus, the 2009 H1N1 influenza virus. We had 11 more influenza
pediatric deaths reported in week 40, which is the week that ends
October 10. Ten of those are confirmed to be due to the new strain, the
2009 H1N1 strain and the 11th is probably due to that but the typing
hasn't been completed. About half of the deaths that we've seen in
children since September 1st have been occurring in teens between the
ages of 12 and 17. These are very sobering statistics, unfortunately,
they are likely to increase.”

From the CDC briefing on Oct 20

“More than half of the hospitalizations are occurring in young people
under the age of 25. We are seeing 53% in people under 25 years of age.
39% of hospitalizations are in people 25 to 64 years of age. And only 7%
of hospitalizations are occurring in the elderly. Almost a quarter of
deaths are occurring in young people under the age of 25. Specifically,
23.6% of the deaths are in that age group. About 65% of the deaths are
in people 25 to 64 years of age… With seasonal flu 90% of fatalities
occur in people 65 and over. Nearly 60% of fatalities are occurring
under age of 65.”

Bottom-line: Get the
shot.

. . .

I understand why it's probably a good idea to
prevent access to some websites from within the hallowed halls of
hospitals, however can anyone explain to me why the IT department of a
major academic/pediatric hospital would block access to the government's
H1N1 pandemic information website?

For whatever reason, the national media haven't quite zero-zeroed in on the
realities associated with H1N1, the vax, and high-risk groups. Certainly,
the tone of local and regional coverage has shifted from cautionary optimism
to creeping negativity.

Whether the media gets
it right or wrong at this point is unlikely to make a dent in the public
perception of being at the heart of something wicked this way comes.

If you were to take a
pulse of America right now, I believe you’d find it in tachycardia with a
hint of all-out gallop as intense fear rides on the cusp of all-out panic.

The indicators for me
arrive on the hour in the form of email queries from healthcare
professionals, community leaders, and emergency management colleagues
wanting to compare notes on what personal steps they can take to protect
themselves and their loved ones from H1.

With so many people with
functional limitations [the vulnerable at the moment] mixed into the at-risk
groups, this ongoing crisis represents a significant challenge for us all.
How do we ensure a fully-inclusive response?

When I've tried discussing H1N1 with some of my
colleagues, there has been tremendous pushback with an accusation of my
'having given in to the hype.' The claims of hype tend to fade as more
people we know are affected by a nasty bit of influenza that has a habit
of going hard after the very young.

Does H1N1 represent the perfect storm with an even more devastating legacy
than that of Katrina?
Katrina struck the Gulf Coast and still managed to impact an entire
generation, create its own diaspora and continues to have a lingering effect
on millions of people. Katrina had a beginning and is still looking for an
end.

H1N1 is an
ongoing evolving global crisis with nothing to link it to the
episodic view we have for emergency management. And unlike all those
other crises occurring out there – famine, civil war, genocide,
malaria, HIV/AIDS – this one is affecting us right here in our
homes. So H1N1 has our rapt attention and even with all eyes on the
‘prize’ we’re still unable to manage this ongoing emergency.

Sometimes it feels as if the professionals would rather not disturb the
peace with discussions focused on what happens when the victims of
emergencies or the emergencies themselves don't act in ways predicted by the
plan.

Were it only so easy if disasters had neither victims nor responders but
only featured rulemakers who could wear funny hats.

It's been a long while since
this happened however it seems the story continues to have a serious impact
on those with whom it's shared.

And that's interesting in and
of itself in that several colleagues have approached me recently because
they've heard this story presented at conferences by folks other than me
claiming it as their own.

Except, of course, for the
part where the presenters accept responsibility for making fateful decisions
because in their telling of my story this happened to 'someone they know' or
'an unnamed colleague' and they proceed to dis' him for his lack of
knowledge about their community.

I was actually very familiar
with the community I served.

I was the director of Cote
Saint-Luc EMS in January of 1998. The City of Cote Saint-Luc was an
interesting place to lead a team of emergency medical services providers.
There was a very high percentage of the population who were 65 years of age
and older and embedded within that considerable slice was a large community
of Holocaust survivors.

Our EMS department was
innovative in its outreach efforts and in its expanded scope of service that
made it more of a psycho-social service than a purely emergency medical
services organization.

On January 5 the freezing
rain storm began to take a toll on the power grid. At 05h00 on the morning
of January 6th, dispatch began to become inundated with calls for
assistance. There were reports from Hydro-Quebec that some 700,000
households were without power in a large swath of southern Quebec.

On January 6 we realized
evacuations were likely to become a necessity. At 11h35 we received the
first of what would be many calls for medical verifications. A 75-year-old
man was on a home oxygen system and plans were made for his eventual
evacuation.

We were sliding further into
crisis. Our calls were multiplying while available resources were shrinking.
People were finding it difficult if not impossible to find a hotel room
anywhere in Montreal.

From crisis we went directly
into the abyss. No need to pass Go. I called for assistance from the
provincial government to assist with establishing shelters for the thousands
of senior citizens and medically fragile residents we were evacuating from
dark, frigid, carbon-monoxide-intensive apartment buildings.

You could not measure the
depth of my despair when I realized no help was coming. That feeling of
profound isolation was almost immediately replaced by the realization that
we would have to take care of ourselves - no cavalry would be riding over
the hill to come to our rescue.

On January 7 at 10h42 our
crews began the assessment of a 10-floor seniors residence. At 10h46 the
transport of the first 16 evacuees from the building begins. They taken to a
shelter established at City Hall. The fire department is called to the scene
to ventilate the building after fumes from the emergency generators
circulate throughout the hallways.

On January 8, Hydro Quebec
reported 950,000 households are without power.

I made mistakes.

We had many senior-centric
highrise or multi-building facilities that had to be evacuated. Given the
sheer number of evacuations and the limited humans available to carry out
the task, we drafted police officers to assist with these mass evacuations.

As police officers, many in
tactical or bulked-up gear due to the extreme weather conditions, went
door-to-door in the darkened hallways, hundreds of Holocaust survivors
flashed back to a time of forced evacuations and transport to the death
camps.

When bubbies and zaidies*
scream.

We had, of course,
unintentionally made matters worse by providing the police officers with
instructions to residents to gather their essentials into a bag as quickly
as possible and then make their way to the lobby where they would be loaded
into buses for the ride to the shelters.

At the shelters we had the
standard line-up check-in procedure. The first round of evacuations resulted
in dozens of cases of severe mental trauma and more than a few syncopal
episodes.

When the plans failed, we
adjusted.

We adjusted by having our
medics accompany the police officers on their evacuation rounds, softened
the approach, used as much light as could be hauled around, brought social
workers into the mix on the buses and altered the check-in procedure to
include large round tables where a social worker and a medic were assigned
to each table to help residents acclimate to their new surroundings.

It became more like a
last-minute social gathering. Thank goodness.

On January 10th, Hydro Quebec
reported 1.4 million households without power. Water had to be boiled prior
to consumption.

On January 11th, the army
arrived with more than 11,000 soldiers on the ground. The Abbruzzesse Family
had power in their kitchen in Montreal North. Huge trays of wonderful
Italian dishes were transported across the city to feed our crews. Smaller
army. Just as appreciated.

I remember a satellite phone
conversation with someone at an agency considering lending us a hand during
the disaster. We were evacuating another 100 or so seniors from a nursing
home at the time. The gentleman on the phone said they might be willing to
send someone to better assess the gravity of the situation. Right at that
moment a large piece of ice dropped off the top of a 20-floor building and
hit a parked car on the street behind me. There was a large crash. The man
on the phone exclaimed, 'What was that?!'

My reply, 'Hell just froze over, sir.'

Be well. Practice big
medicine.

Hal

*Bubby and Zaidie are the
yiddush words for Grandmother and Grandfather respectively.

If you had to pick someone who would be the least likely to become addicted
to road cycling more than 30 km each and every day at speed you need not
look any further than me.

So, it's a bit surreal to think that come July 2010, I will be joining
thousands of other cyclists riding the 250 km [in two days] from Montreal to
Quebec City to raise funds to support the fight against cancer.

I'm riding for Abraham,
Rose, Mimi, David, Susan, Gil, Mario and many many others who fought cancer
right up until their dying breaths.

We say the words
carefully. Sometimes in a hushed whisper. Sometimes spat out like a foul
taste in our mouths. “Cancer” ... “The Big CA”

So many family
members and friends and colleagues who have waged pitched battles
against cancer.

Occasionally there
are wins - and we celebrate those in grand style although truth be told,
once cancer stages a home invasion it never really leaves. Even when
it's gone for good, we all wonder if cancer will find another way to
come back into our lives.

More often than not
there are losses. And we mark those with sorrow and tears and a lasting
hatred of a disease that shows no mercy and knows no boundaries.

I spent a good chunk
of my career as a paramedic/firefighter. Cancer has become inexorably
linked with those who are on the frontlines of emergency services.

I've gone to the
hospital to pick-up a friend/colleague after his first round of chemo
and I'll always remember his reaction to being able to walk, albeit
weakly, out the door under his own power. It was a cold, crisp day and
yet he had his window down for the ride home so he could take in the
sunshine and the wind. His cancer was beaten back and he's still a part
of our lives.

I'm riding for Norm and Don and not enough others
who have found a way to beat cancer. Norm Rooker, my
brother-of-another-mother, wrote about learning he had bladder cancer in
this very personal essay he wrote for Big Med in 2007.

I'm riding because I never ever want to answer the front door again to find
a friend so visibly shaken my wife didn't even recognize his face. A
firefighter/medic, he had been diagnosed with kidney cancer. He knew
something was wrong and even verbalized the probability of cancer before
being whisked into a CT scan by a physician who feared the worst.

Of all the private and public hells a firefighter must tackle in the course
of his/her career, I cannot imagine the fear and uncertainty that comes with
the word, "Cancer." As a firefighter, I was always aware of the risks that
come with 'the job' but somehow you never think that one of those risks will
come home with you and change your life forever. Certainly, there's the
possibility of injury or even death battling blazes or effecting rescues but
those are risks we've accepted and worked into our view of life and career.

Cancer wasn't part of the bargain. And yet, here in Canada, thanks to
efforts of a few determined firefighters in Winnipeg and Ottawa, several
provinces have added “firefighters’ presumptions” to their workers’
compensation laws, deeming certain types of cancers to be related to work as
a firefighter unless the contrary is proven. Kidney cancer is high on the
list.

I'm riding because Mario Peloquin deserved so much better than to have been
killed by a particularly aggressive form of cancer. Mario was a paramedic in
Sorel-Tracy [about 90 km from Montreal]. He was a lover of jazz and
classical music and a musician in his own right. He was a treasured dad. I
attended his funeral because I wrote about the efforts of his EMS brothers
and sisters who had tried so hard to ease his final passage.

I’m riding because
cancer needs to be beaten back into a corner and then squished like a bad
bug - with a big boot.

I am committed to raising as much money as I can - with $2500 set as the
minimum. I am looking for corporate sponsors willing to match the donations
made by individual donors. I am hoping to find others who would like to join
me on the ride and in the fight against cancer.

I have a strange relationship with the Government of Quebec's Health
Insurance Agency. Every couple of years they declare me dead.

They don't actually check to see if I have pulse. No one comes over to
verify whether I'm breathing - or not. They don't even send an Sp-3 form
over to the house for any physician friends of ours to complete.

They just notify the Director General of Elections for Quebec that I no
longer require a Quebec Medicare card because I've ceased to exist. And then
the Director General of Elections of Quebec sends a note to tell me that my
name has been stricken from the electoral list.

Then I call the Elections folks and assure them I am very much alive, still
paying my property, income and corporate taxes, still hold a Canadian
passport and have recently renewed all kinds of forms for other Quebec
government agencies including my driver's permit and our vehicle
registration.

And then we talk about how strange a situation this is.

And I tell them about the last time the Health Insurance folks declared me
to be null and void and no longer in need of a Quebec Medicare card. July 7,
2007 was the last time this happened. Actually, it happens every couple of
years on randomly selected dates.

The Elections folks have a theory that some bureaucrat is jerking my chain
because of the randomness of the dates. They say that if the notification to
them that I am pushing up the daisies was at least tied to the date my
driver's permit expired, they could write this off as some kind of bizarre
one-in-nearly-eight-million IT system error.

The apparent randomness of them receiving notification of my sudden
departure from this address and this plane of consciousness leads them to
believe that someone is deliberately tampering with my supposed-to-be-sacrosaint-data
in their allegedly-secure database.

This does not give me the warm and fuzzies when I consider the future of
electronic health records. You have to wonder how it's possible for one
citizen's records to be altered on an ongoing basis. And while the deletion
from the ranks of the living strikes me as a very serious concern, the
Elections folks are aghast that someone could have their right to cast a
vote eliminated in this manner.

They weren't going to let this slide. They framed a strategy. They said I
needed to reach out to my local elected provincial representative and let he
and his staff know what had happened. And if that doesn't work they
suggested dropping a line to the Premier's office. No one has the right to
mess with your right to vote. Not in this Province. Not on their watch.

The good news is that I have been restored to the electoral list and can
vote in the upcoming municipal elections. The bad news is that there is some
concern that I'll be having the same conversation with the folks at the
Elections office in two years, give or take a month, when news of my death
is greatly exaggerated once again.

I’ve been looking at
medical surge as a series of ever-larger waves crashing ashore in that they
continue picking up more and more debris and carrying that further inland
until finally they begin to ebb.

All the surge plans I’ve
seen are based on the notion that the emergency healthcare system will need
to handle more and more patients until finally the peak flow is reached.

There is a fair bit of
‘resurrection medicine’ built into these plans – the need to reach into
death’s door and pull the victims back into the land of the living.

Shouldn't we be looking at
creating critical care field triage levels that would prevent the surge
waves from carrying patients requiring resurrection-medicine from reaching
the ERs? Isn't it about time we took a hard look at plans that would include
field-based palliative care units?

Any idea on the total
number of mechanical ventilators and respiratory techs there are in any
given major jurisdiction in the United States or Canada? Anyone have a
breakdown on that number per hospital – just the major centers?

So now that we're seeing a strong run on tickets for a
possible Kick Your Ass tour for A/H1N1 in the fall, does anyone
have any idea what we can anticipate in terms of both clinical attack and
absentee rates when it comes to the respiratory techs themselves? Has anyone
got any ideas about who to train and how to train them in Ventilation for
the Uninitiated?

Does anyone have numbers for pediatric vents and resp
techs at pediatric centers? It seems that the vast majority of
hospitalizations in a more virulent return of H1N1 would be among children
below the age of 15. Unless I've missed something, we just do not have the
collective pediatric resources to provide care on that scale.

The estimates I've heard sure
don't give me any peace of mind - and the fact that the actual numbers seem
to be so closely guarded also gives me pause. Certainly don't get the vibe
there are overwhelming numbers of either ventilators or the human beings
required to make them effective lifesaving tools.

As my friend Roy says, "It has been nearly five years
since the discussion of vent shortages in the United States began with SARS
as the stimulus. So, in five years the US has apparently done little to
increase the number of ventilators available for pandemic flu surge and
train a much-enhanced healthcare cadre to manage ventilator systems in
compromised patients."

The problem is, as Roy so aptly quips, "Vents are not
particularly sexy or worthy of discussion in a healthcare system barely able
to manage a bad season of colds and flu."

My educated guess would be that roughly 85 percent of
the available mechanical ventilators in Montreal hospitals are currently in
use. Combine that with an average ER occupancy rate in the 90-something
percent range and we're not talking surge - we're talking about a damned
near bankruptcy of the emergency healthcare system.

Roy's educated guess is that the same percentage of
current daily use holds true for the 100,000 or so ventilators available
across the United States at any given moment.

While I recognize the wonderful
work done by major trauma centers that kick themselves into overdrive to
deal with 20-30 seriously injured patients from a single incident, I believe
it's time to take a real-world look at what happens when there are 100 or
200 or 300 or maybe 1,000 people who are sick or injured?

Or when there are tens of thousands of people concerned
about their children who are presenting with the signs and symptoms of
pandemic flu.

And perhaps it's not a one-time
event.

I live in Montreal where the EMS
system runs on a Basic Life Support platform and where firefighter-first
responders have been limited to a SSU [sticky side down] approach when it
comes to providing care for patients prior to an ambulance crew's arrival.

The idea that somehow the
combined Fire/EMS system would be able to successfully triage, then
transport more than 100 critically ill patients from a single incident
without completely outstripping available resources is pretty well pure
science fiction.

The EMS system is constantly
short of ambulances and crews. There are a finite number of firefighter
first responders. And that's when the going is relatively good. Throw in an
icy night and a few multi-patient car crashes and maybe simultaneous
multi-alarm fires [definitely not unheard of in a major metropolitan area].

And we don't need to be talking
pandemics or terrorism. We could be talking about an ethyl-methyl-bad-stuff
incident at one of the multiple chemical facilities that are smack dab in
the middle of a heavily populated center. All that's required to tip the
balance between feasible and outright chaos is a higher percentage of
critically ill patients.

If the walking wounded aren't -
then we've got a serious problem on our hands. It's not as if we're going to
tell the populace to get a pick-up truck and an air mattress and take their
neighbors to the ER on their own. One major incident doesn't come with
permission to suspend operations for the rest of the population. Just
standing with Serge and talking with Roy watching the waves crash on Tundra Beach.

They singled Jamie
out because he was a Jew and saved him for last so he could, presumably,
be further tormented before they shot him at point blank range.

They should have
singled him out because he was a good streetmedic. He was.

I still miss him.

I wrote this about
his death:

“Jamie Flanz was
murdered two springs ago. His passing had no connection to the EMS world
other than the fact that his obvious state of death probably didn't
require a streetmedic to declare the absence of life signs.

He was a good medic
and was a gentle, reassuring presence with many of our most senior
patients. He put in many a shift at the last minute because I called and
asked for his help.

It is the transient and intense nature of EMS that lifesavers often come
and go without much in the way of heralding their arrival or their
departure. They touch lives and impact universes and then they move on
to live the rest of their lives.

There are,
apparently, no guarantees on how long the rest of their lives will
be. Maybe some of them have an inkling of sunset rapidly approaching and
decide to go out flaming while others simply pull the bedcovers up over
their heads.”

One of my close
friends and colleagues in EM, Elizabeth Davis first introduced me to the
concept of signing a thank you to the troops – starting with my hand
over my heart and then putting my hand out – a thank you from the bottom
of my heart. At first I felt self-conscious when signing my thanks to a
soldier however after seeing their reactions that salute/sign has become
a regular feature of my ‘vocabulary’ when I cross paths with someone
courageous enough to don the military uniform and volunteer to serve.

Expressing my thanks
via such a simple gesture never fails to elicit a significant smile or
wave or expression of surprise from the soldier. And it never fails to
make my day seem just a bit brighter.

The gesture
transcends borders and politics.

Here’s the link to
the Gratitude Campaign. Check it out. One thank you sign at a time…

Despite the recent
rah-rah session aka the Flu Summit in DC and all the good tidings that
flowed forth from that 'rather vacuous' gathering, I have serious
concerns about what awaits us as H1N1 circles the globe and comes
streaming back towards us as a virulent mo-fo capable of creating the
tipping point that sends healthcare systems well over the edge and into
semi-permanent surge status.

WHO has recently
recommended that all nations should immunize their healthcare providers
as a screaming priority in order to protect the health infrastructure.
Remember, folks, that’s the same health infrastructure that’s currently
operating well beyond normal capacity on an ongoing basis despite the
fact real life has been in the fat dumb and happy zone in between
natural disasters and man-made catastrophes for years.

There are problems
with the production of a workable flu vax [perhaps as far down the road
as 10+ months] and there are rationing schemes afoot with
country-specific customizations on order of priority of the following
groups: pregnant women; those aged above 6 months with one of several
chronic medical conditions; healthy young adults of 15 to 49 years of
age; healthy children; healthy adults of 50 to 64 years of age; and
healthy adults of 65 years of age and above.

And so, as my pal
Roy says, even mid-2010 does not mean global coverage, just those that
can afford it or have special arrangements. Perhaps it’s time we
considered home schooling..

Do not take the
mainstream media’s inability to deal with its own Attention Deficit
Disorder lightly. While it’s somehow amusing to watch CNN’s Situation
Room monitors flicker with images ranging from Jocko’s funeral services
to the uprising in the streets of Tehran, keep in mind these are the
times we need to be looking at our emergency services’ capabilities with
the eyes of a malevolent red team because the wicked things that are
inbound will surely stretch the anticipated limits and then some.

I am just back, bare feet tucked under desk, typing away on my keyboard
after spending three game-changing days at the Ogma gathering at the Navy
Post-Grad School in Monterey, California.

Thoughts in a non-linear somewhat faithful to chronology flow:

Ogma. Celtic god of alphabet.

A River of information runs through us. There is no point in pretending that
it is somewhere out there and that we have the option of turning our heads
away in order not to see or feel the flow.

The much sought-after ideal of true community resilience depends on our
willingness to embrace the notion of the River - W2.0 - social media.

An enormous obstacle comes in the form of ensuring there is an interactive
flow of information. We need to create real, not intangible BS, value-add
for both providers and consumers of information.

Are we perhaps afraid to acknowledge the River because to do so is a tacit
admission that we have somehow lost control of the flow of information? Are
we migrating between stages in a grieving cycle linked to the proliferation
of social media?

Are we, as emergency management practitioners, confronted with the reality
that our position in society is in flux? That's a terrifying concept for
many leaders to confront. Organizational change is usually measured in
multiples of years. How do we create a framework for a phenomenon evolving
at an exponential pace?

What are our known needs? How can we know what we need if we have not yet
accepted the mere notion of the possibilities available?

We are excellent at creating networks but how do we measure whether or not
we have achieved the key element identified by multiple Ogma players - how
do we measure Trust? How can we rebuild a social network on the fly if it is
compromised? What are the metrics we are using to measure Trust?

Before I set out for Ogma one of my daughters asked if there was going to be
a test at this gathering. I told her the whole thing was a test I couldn't
study for.. turns out I was right.

Where do we go from here? How do we get there? Are there any lines on the
horizon or is everything stitched together seamlessly in varying shades of
grey?

The Adopt A Highway program was created to promote community pride and to
help carry out or sponsor activities such as mowing, weeding, landscape
beautification and litter pick-up. There's even a company you can pay who
will provide the cleaning so that you can receive the recognition and
'display your civic pride.'

While adopting a section of the Trans-Canada Highway would certainly give me
the opportunity to put Big Medicine's name on a sign that would be seen by
thousands of motorists each and every day, I've been thinking that maybe
what we really need is an Adopt-A-Medic program.

We could donate a bit of money each month to an organization that would be
tasked with ensuring our adopted medic's family can afford more than just
the basics. Basics that are hard to come by when our government continues to
pay the same base salary of the old days while continually adding to the
individual responsibilities of the medics and simultaneously refusing to
bolster support for the system itself.

Daniel Garvin is a street medic in Montreal. We've known each other for a
couple of decades. He's still working on the ambulances. I'm 49 years old
and I cannot even imagine hauling myself into those garages every morning to
start a shift. It's a tough job. It tears at your heart and it hammers away
at your soul. It follows you home even when you try to leave it in the rig.
It has to be a calling because otherwise who the hell would voluntarily take
on such an insane role.

"One of the biggest hardships of being an EMT-P here in Montreal is
obviously the salary. While many of my friends and neighbors ask why do we
continue to work in such conditions, my answer is always the same, we are in
this for the people, not the money. I feel that EMS is a calling, more than
just a job."

"Most people I know have the regular 9-5 boring obligation and rarely talk
about the workplace in social circles. On the other hand, whenever we gather
socially, my job always sneaks its way into the conversation. "Busy week
Dan?" "Did you work that accident on the 40 the other day?" "Any news about
your contract?"

"The paramedics that I work and am associated with in other systems are
dedicated to rendering the best possible pre-hospital care they are capable
of giving. The salary is secondary.

"Lately though, our employer has been putting more responsibility on our
shoulders and not matching that with compensation. When I began in EMS some
24 years ago, we were officially trained to perform CPR and administer
oxygen to patients in need. That was almost the extent of our services in
the medical sense and the salary reflected that.

"These and many other interventions are what make up our day on a regular
basis and we are still being paid the base salary of the old days. When will
we be recognized for what we do?

"Our families do without because of this injustice. Paramedics
in Ontario are being paid properly and doing the exact same job we do here
in Montreal, paramedics across Canada are being treated much better than
Quebec."

Danny would likely punch me, hard, if I told him my idea about the
Adopt-A-Medic program. He's not the kind of guy who has ever sought a
hand-out in his life. He is a feet-on-the-ground family man who is the kind
of paramedic I'd entrust the lives of myself and my family with. He is a
hard core street medic. You need to be pretty damned hard core to continue
working in an EMS system that has been Circling The Drain pretty much since
the day it was established.

The more I think about the Adopt-A-Medic program the more I like the
concept. We could become sponsors for Quebec's paramedics. They could wear a
patch on their uniforms with our names on it so the people they encounter
each day will know that our paramedics are a source of civic pride - at
least for some of us.

Of course, I realize that it's the role of our government to adopt and
embrace our paramedics and treat them with respect and appreciation. I have
never understood the government's unwillingness to recognize the importance
of the people who provide our emergency medical services.

After all, no matter who you are, when the shit hits the fan and you're
critically ill or injured, your life will be in the hands of Daniel Garvin
or one of his colleagues. I already know they'll do their best in those
extraordinarily difficult moments.

What I'd like to be assured of is that the government is doing its best to
support them and their families with a real-world living wage, with a
generous pension plan, and with resilient support systems that will stand
the test of time and changes of administrations.

Last evening I exchanged notes with a well-regarded television journalist
who seemed to be actively refusing to acknowledge the importance of
news-on-the-net via social media as a real-world alternative to the nightly
newscast.

The discussion was surreal at best. She truly believes 'we' need her and her
colleagues to be our filter because we can't understand the facts on our
own. 'We' need journalists to decipher the code for us.

When I mentioned that near-real-time situational awareness already exists
via the net her reaction was almost comical were it not so damned tragic:
She warned me about the dangers of too many fragmented views.

My friend Andrew Fielden [follow him on Twitter
@AndrewTF] reminds
me on a regular basis that no one service provider can have a monopoly on
the sources of the data.

He attended last week's Media140 gathering in London and among the many
comments he made afterwards was that "Twitter
itself is seen as the latest threat to the media in that it appears to allow
people to go direct to the source in real time and create an instant news
thread which require only the presence of the microblogs and linking through
to blogs and other supporting digital elements."

So what happens when the 'great unwashed' are unleashed and able to generate
news of their own making? Are there any guarantees that what they produce
will be any less important than that which is professionally produced in a
multi-million dollar studio?

I think not. Often, I am struck by the incredibly poor job the
'professionals' do at communicating a story. Last week, I read an op-ed in
the Washington Examiner wherein the name of a man who was sent to Syria and
tortured because he was mistakenly suspected of being a terrorist was
replaced by the name of a man awaiting trial for allegedly killing an
American medic in Afghanistan. Do not disturb with the facts. Professionals
at work.

In emergency management, we talk about situational awareness as if it were
the holy grail and in many ways it is. That ability to sift through multiple
streams to pull the essential nuggets out on an ongoing basis is at least as
important as the ability to craft a compelling narrative to ensure the
information can be shared effectively.

However, the key to gaining that type of perspective is knowing what kind of
nuggets you need to be fishing for at that moment in time - or more
importantly, for the next several moments in the future.

Retired Canadian Forces Col. Richard Moreau [now a VP with Ottawa-based
Prolity] teaches a
serious 'leadership in crisis program' that emphasizes the need for
intelligent awareness. According to Richard, if you don't provide guidance
on what you're looking for, don't be surprised when your intel crews come
back excitedly proclaiming, "We've got cod! We've got cod!"

At some point, you're going to have to explain to them that you were looking
for swordfish.

Which brings me back to my exchange with the television journalist. I'm not
sure what she's fishing for, because of course, there's no way for the
collective 'us' to provide her with guidance on what we believe is
important. It was clear in the course of our brief conversation that she
thinks she knows what we need to learn and that we would be lost without
these self-anointed guides. She mentioned words like 'trust' and
'credibility' however left out key terms like 'depth of understanding' and
'real-world expertise.'

So, I go fishing on my own, looking for a spectacular mix of views, opinions
and facts from which I will draw down my own intelligent situational
awareness.

I don't need a nanny journalist to 'sort it all out' for me every evening.

This morning I received the
following press release from a colleague in the United States. I've
highlighted the passage of greatest interest to me.

Release No. 0142.09

Contact:

Statement By Canadian
Minister of Agriculture and Agri-Food Gerry Ritz, U.S. Secretary of
Agriculture Tom Vilsack, and Mexican Secretary of Agriculture, Livestock,
Rural Development, Fisheries and Food Alberto Cardenas

May 02, 2009

"We would like to express
our deepest sympathies for the victims of the current outbreak of H1N1
influenza and emphasize that our governments are doing everything they can
to bring the outbreak under control.

"We strongly urge the international community not to use the outbreak of the
H1N1 influenza as a reason to create unnecessary trade restrictions and that
decisions be made based on sound scientific evidence. H1N1 influenza viruses
are not spread by food. International organizations, including the World
Health Organization (WHO), Food and Agricultural Organization (FAO) and the
World Organization for Animal Health (OIE) all reiterate that the
consumption of pork meat and related products do not present a health risk
of contracting H1N1 influenza. Canadian, American and Mexican authorities
have emphasized that they have not found a case of influenza in swine herds.
All three of our countries are committed to ongoing monitoring and vigilance
in both public and animal health.

"The current outbreak of H1N1 influenza, which is being spread from person
to person, is being addressed by the health and sanitary authorities of our
three countries, emphasizing the need for cooperation and a common front
against this new virus. In addition, we fully support OIE efforts to alert
and disseminate relevant information published by its members' laboratories
in real time about the disease."

___

This afternoon I received
word from a trusted source in Canada that two pig farms in Alberta
[Clearwater County] were
under quarantine after the first probable human-to-swine transmission of the
A/H1N1 flu virus. A farm worker returned from Mexico after contracting the
disease. The virus found in the Alberta pigs is the same strain of A/H1N1
found in human cases. [The carpenter, the producer,
and the producer's family had been ill with flu like symptoms between 14-29
Apr]

The story is now being
reported in the mainstream media.

The question I would like to
ask is, "How long has the Canadian government known about the situation in
Alberta?"

Just curious because,
according to CTV News, "when a lab cannot identify the subtype, it has to be
sent to the National Microbiology Lab in Winnipeg which is the only lab in
the country that can confirm this new strain of H1N1."

The testing process takes
more than just a few hours so you'd begin to wonder what the
chain-of-discovery would look like on the political level. Who would make
the decision to go out with a statement reassuring people the swine herds
are safe? Would they be in the same information loop as those working to
confirm the genetic makeup of the virus affecting the pig herds in Alberta?

[Updated May 6 2009] - And the answer to this question "How long has the
Canadian government known about the situation in Alberta?" is - since
April 21st as a possibility, April 28th as a probability and since May 1st
as a certainty.

"A Canadian Food Inspection
Agency (CFIA) team attended the premises on 28 Apr [2009] and collected
samples from swine for influenza virus testing. Swabs and serum samples were
received at the CFIA National Centre for Foreign Animal Diseases (NCFAD) in
Winnipeg on 29 Apr 2009. The samples were run in conventional RT-PCR for the
Matrix and the H1 gene (primers kindly provided by the PHAC [Public Health
Agency of Canada] National Microbiology Laboratory, Winnipeg). These results
showed that 19/24 samples were positive for the M gene and 15/24 samples
positive for the H1 gene."

It's interesting because when
I searched on Google for "Release No. 0142.09" I found myself on the
Newsroom of the United States Dept of Agriculture website with the following
notation:

This is yet another example
of the communications disconnect that has plagued [sorry] the A/H1N1
outbreak from the start. One mouth has no idea what the other mouth is
saying. All speak and no listening.

One scientist says we have
nothing to fear. The other says it's only a matter of time before things get
worse.

Be well. Practice big
medicine.

___

PS. Received the following at 18:30 this
evening.

CANADIAN FOOD INSPECTION AGENCY

May 02, 2009 18:20 ET

CFIA: An Alberta Swine Herd Investigated for H1N1 Flu Virus

OTTAWA, ONTARIO--(Marketwire - May 2, 2009) - The Canadian Food Inspection
Agency (CFIA) indicates that it has found H1N1 flu virus in a swine herd in
Alberta. The safety of the food supply is not affected and Canadian pork
continues to be safe to eat.

It is highly probable that the pigs were exposed to the virus from a
Canadian who had recently returned from Mexico and had been exhibiting
flu-like symptoms. Signs of illness were subsequently observed in the pigs.
The individual has recovered and all of the pigs are recovering or have
recovered.

While further testing is needed to more fully characterize the virus, the
CFIA is taking a precautionary approach. The herd has been placed under
quarantine, and the Agency is working with public health colleagues to
determine the most appropriate next steps to ensure that public and animal
health remain protected. The chance that these pigs could transfer virus to
a person is remote.

Influenza viruses do not affect the safety of pork, according to the World
Health Organization (WHO) and the Food and Agriculture Organization of the
United Nations (FAO). As with any raw meat, pork should always be properly
handled and cooked to eliminate a range of food safety concerns.

Pigs in Canada are tested for influenza viruses on an ongoing basis across
the country during routine investigations into respiratory illnesses. The
CFIA is working with provinces, territories, the swine industry, and private
sector veterinarians since April 24th to enhance monitoring of swine herds
for signs of illness and to maintain enhanced biosecurity measures on farms
across the country.

___

Which begs the questions:
How would it be possible for a farm worker "exhibiting flu-like symptoms" to
be in contact with the herd on a swine farm? Were there no bio-security
protocols in place?

Our out-of-hospital
care system needs to be redesigned by people who are dedicated to the
needs of the end-users [I despise the words ‘patient’ or ‘beneficiare’
because ‘patient’ implies you must wait before receiving care and
‘beneficiare’ implies that healthcare is a benefit - and not a basic
right] and the people who actually deliver the emergency care.

We need to stop
looking at prehospital care as a back-loaded system that starts when an
imaginary stopwatch is triggered after someone recognizes an emergency
has occurred and calls 911. The problem with this model is that the
clock will continually be reset once the person in need has received
treatment and has been delivered to the ER. No one is looking at ways to
prevent the emergency in the first place.

How many
healthcare workers come to Quebec from other jurisdictions and are held
in place while exams are written and scores are compiled? Why can’t we
create an EMS/CLSC-linked organization that trains people to visit
clients in their homes, verify that their environment is safe, check
that their meds are up-to-date, check their vital signs, even run an ECG
or draw bloods to be checked at a local hospital?

Wouldn’t it be
economically and socially advantageous to have a first response team
specially trained to respond to calls of a lower priority to determine
whether or not those clients actually need to be attended to by the much
scarcer ambulance-based medics? I’ll bet that could substantially reduce
the number of times the words “aucune ambulance disponible” are
transmitted to waiting first responders.

The firefighter
first response program is performing beyond expectations. It needs to be
expanded beyond the Island of Montreal and should encompass every part
of this province. Firefighters who believe in the possibilities need to
engaged as emissaries for this approach - they need to become part of a
core of leaders who can mentor other firefighters. I’m tired of watching
naysayers rise to the top of the leadership ladders. Fire dept first
response should be funded appropriately and cities and towns should
start realizing that this is an investment that assures tax payers of
living long and fruitful lives - and continuing to contribute to Quebec
society.

There should be
automatic external defibrillators [AEDs] in every public building and
many of the private ones. Police officers should be equipped with AEDs.
CPR courses should be a requirement to graduate from elementary school.

We should have
advanced life support [ALS] paramedics on every ambulance - and when
we’re done with the ambulance crews we ought to start looking at ALS
firefighter medics. We need to pay the ambulance medics a living wage
that recognizes the enormous contribution they make to our lives - and
not treat them as some afterthought to the system. Without them the
crippled system would have collapsed long ago. And we reward them by
treating them as second-class citizens and trying to find ways to refute
their CSST claims after their backs and legs fail after decades on the
job.

There should
never be a monopoly on saving lives or helping people in an
extraordinarily difficult moment of their lives. That damned clock
begins ticking when someone calls for help. The primary consideration
should be who can get there quickest to render aid - not which response
organization has a ‘claim’ to the territory.

Every EMS
organization should take an enormous leap of faith forward, work with
all of the stakeholders and establish a model that ensures everyone in
the community gets the emergency care they deserve.

My family
deserves the best emergency medical system available. Doesn’t yours?

Suggestion: Talk
to your MNA - your elected representatives and ask them why they believe
your family deserves anything less than the best possible prehospital
care. Our prehospital care system is nothing if not equitable in
delivering substandard services so it really doesn’t matter if you’re an
MNA or not when you or someone you love place that call to 911.

Natasha Richardson died yesterday.
She succumbed to injuries suffered on a beginner's trail at the Mont
tremblant ski resort. She was 45-years-old.

Some folks have suggested that a
neurosurgeon and an MRI within two hours of injury might have made a
difference.

Sacre Coeur Hospital is a long haul [about 80 km - 36 miles] from the
Ste-Agathe Hospital where Ms. Richardson was initially transported - that’s
a very long ride in an ambulance.

I cannot help but wonder if the outcome might have been different if the
accident had occurred in a jurisdiction with advanced care paramedics and an
integrated helicopter medevac system that would have ensured rapid transfer
to a tertiary care facility.

And that lingering doubt shows no
sign of fading, especially in light of the news this morning that the first
ambulance crew called to the scene left without ever even seeing Ms.
Richardson.

Interestingly, when there are
NASCAR or Formula One races in Montreal, there are medevac helicopters on
standby to transport injured drivers from the track to one of the two major
trauma centers that serve Montreal.

Sadly, that’s not the case for the rest of the year and for the rest of the
people.

So,
while there are Advanced Life Support paramedics based on ambulances,
firetrucks, and helicopters everywhere else in the G8 - here in Quebec, the
powers-that-be have decided ALS paramedics are just not necessary for the chain
of survival.

That’s your chain of survival, folks. To quote
Jim Duff,
“It’s the system that begins with a 911 call and ends when the hospital
moves you out of intensive care — or to the morgue.”

In
Quebec, we don’t have Advanced Life Support paramedics because, despite the
embrace of all things secular, when it comes to our provincial Emergency
Medical Services [EMS] system we have placed our faith in God – and the
skills of the resurrection specialists working in our hospitals' ERs.

If
God is smiling down upon you, you just might survive the ride in the
ambulance that delivers you into the hands of his emissaries in the ER.

With
one of your feet already firmly planted in death’s door, the nurses and
physicians of the ER will do their darndest to successfully pull you back
towards the light. And once you’re confirmed to be back among the ranks of
the living, there will be high-fives all around in the crash room as yet
another soul has been saved.

And
if you die, well, you died because you were destined to do so despite the
best efforts of the team waiting in the Emergency Department.

You
just cannot have an effective Advanced Life Support Emergency Medical
Services [EMS] system in a society that has bought a lifetime prescription
to the notion of supporting a monopoly on who should save lives.

Perhaps one day soon we will begin placing our faith in the people who have
the wisdom, experience and courage to work the frontlines of emergency
medical services instead of having them continue to serve as the pick-up and
delivery service for the ERs.

In
the meantime, you can try praying for a miracle.

There should never be a monopoly on saving lives or helping people in an
extraordinarily difficult moment of their lives.

"Yesterday I received news that a
young firefighter/medic had taken his own life. Another gatekeeper of the
cracks who somehow managed to slip into the abyss that exists in the shadows
between the ranks of fellow EMS providers. 'He was a gentle soul who was
genuinely caring and a real pleasure to work with'... and he was practiced
in the art of self-isolation enough to drift in ethereal misery until he
finally capped his own existence" - October 2007 Big Med"

"The first people to arrive on the scene, emergency services personnel
witness traumatic events with every shift. Yet they continue to perform
their essential duty of saving lives -- often in the face of unspeakable
tragedy. So unspeakable, in fact, that many of these heroic individuals
struggle quietly with the physical, psychological and emotional effects of
their jobs." - the Tema Conter Memorial Trust
www.tema.ca

Vince Savoia is one of my heroes. Not for the work he
did as a paramedic although I am certain there were heroic moments in those
days.

It is the work he has done since responding to Tema
Conter's murder in 1988 that strikes me as filled with sacrifice,
dedication, passion and a real sense of purpose. After coping with
post-traumatic stress as a result of responding to the call, Vince
established the Tema Conter Memorial Trust to honour the memory of Tema and
to call attention to the acute trauma encountered by emergency services
workers.

Tema Lisa Conter was born and
raised in Halifax, Nova Scotia. She was the daughter of the late Dr. Ralph
Conter and Deborah Conter, and a sister to Howard and Arlene. Tema was full
of life and happiness, and lived life to the fullest. Throughout her school
years, university and career she was known to her many friends for her
humour, wit and charm and always as the life of the party. Her special
personality connected her with people of all ages; once that connection was
made they were forever her “buddy”.

Tema was especially loyal and
devoted to her family, coming home for visits at every opportunity, also
making her grandmother, the late Ruby Hamburg, her top priority. She was
generous and caring to her friends, never begrudging the happiness of others
but always finding joy in their good fortune. After graduating with a B.A
from McMaster University, she then furthered her education at the School of
Retailing at Chamberlain College in Boston, majoring in fashion
merchandising. She moved to Toronto in 1985 and began a career in fashion
management. She worked as a buyer and manager for an established ladies wear
retail chain.

On January 27, 1988 at the age of 25, Tema was murdered by a convicted
serial killer who had spent most of his adolescent and adult life in jail.
In a fatal error of the justice system, this man, who had been placed in a
half way house , in a mid-town Toronto neighborhood, entered her apartment
building early that morning and attacked Tema while on her way to work. Her
brutal and senseless murder, a nightmare beyond belief, was reported in
detail in all of the papers.

Someone asked me if I had
ever been affected by PTSD and I replied, "Does waking up in bed,
sitting and screaming aloud - every night for three weeks - count?"
Often it is not the single event that shakes us to our core. It is an
accumulation of seemingly disconnected stressors that are stored away
carefully in the recesses of your mind, only to suddenly re-appear when
you least expect it.

Vince and I talked yesterday
about how it ought to be required to provide every single emergency
services worker - volunteer or career - with a solid awareness-framed
education about the elements of stress management. It is really time to
talk opening about Critical Incident Stress and Post Traumatic Stress.
The days for stoic never-shed-a-tear superheroes are done.

Recognizing that early
education is very important, each year the charity grants The Tema
Conter Memorial Trust Scholarship Award, an annual scholarship available
to all emergency services students (to include EMS, Fire, Police, and
Emergency Communications students). The $2,500.00 scholarship is awarded
to the student who best discusses, in an essay or journal, the
psychological stressors of Critical Incident Stress and Post Traumatic
Stress Disorder and their effects on the personal and professional lives
of emergency service personnel.

The Tema Conter Memorial
Trust has published a $5 booklet on
Stress Management for Emergency Personnel. The
booklet identifies signals of distress and provides guidance on learning
how to cope. It's five bucks that will be well spent. Drop $50 and hand
them out to all the emergency services folks and their folks in your
life.

This is one of those rare
occasions when a tragic EMS call provides the nexus for friends and
families of the victim and the responders to work together to create a
wondrous powerful legacy. And that's another reason why Vince Savoia is
one of my heroes.

Big Med is proud to announce the launch of our tick-it
- a powerful communications tool designed to link the Big Med Community via
a ticker that resides right on your desktop, laptop or mobile phone. The
tick-it is persistent and does not require a browser. Nothing is stored on
your computer. And it's free.

tick-it allows members of the Big Med Community to
share messages and information while helping organize updates and alerts.
tick-it gives each of us the ability to create our own groups - to invite
others to share the experience - and to transfer essential info across a
busy, fragmented world.

You'll need to play with the tick-it a bit for you to
get the hang of it - however it's a quick, easy and fun learning experience.
Like CNN and other news tickers, there's a stream of headlines [click on
each one to see more of the story and any links].. The remarkable difference
with tick-it is that each of us can add news and information to the stream.

Right now, you're invited to join the Big Med Alerts &
Info tick-it stream. As soon as you're signed-up for that tick-it group,
we'll invite you to join other groups designed to deepen the stream of
information being shared. You'll be able to monitor multiple groups or
channels simultaneously, or you can switch between them like TV channels.

Remember, the Big Med tick-it is designed to empower
our community. You'll be able to interact with content, post your own news,
and share stories with your friends and families - seamlessly and securely.
Enjoy!

When confronted with unfamiliar territory and a
survival situation, many people follow a line of cascading decisions that
lead to the unthinkable - they run away from rescue.

I understand how the average Jack/Jill can end up
rejecting the omnipresent dangers inherent in a survival situation and do
everything in their power to hold on to the familiar instead of embracing
their new environment. I understand how those decisions can lead to someone
sticking to what they believe is the trail and walking over the edge of a
cliff.

What I don't understand is how a supposedly seasoned
emergency manager can make the same type of conscious decisions on behalf of
his/her constituents and do everything in their power to prevent new ideas
from circulating in their fiefdoms in the midst of a disaster. By refusing
to embrace the new environment, they are, in effect, leading the move to run
away from rescue.

Yesterday, I found myself having to explain that
someone reaching out for assistance in the midst of a disaster probably
wasn't looking for a political leg-up. It was a surreal conversation due in
part to the fact that the folks doing the reaching out were just trying to
help the citizens who rely on them for help in a crisis. You might have
guessed that wasn't the surreal part.

You're right. The surreal part was trying to convince
a senior emergency management advisor that maybe it was just help
these people were seeking and not a threat to the political status quo.

I went with the following line:

"So, what would be the ulterior motive of someone
calling from a church in the midst of a disaster zone to my office in
Montreal asking for help getting extra supplies to his congregants. All the
while, he knows he's reaching out to someone in a different country - except
he doesn't see it that way - he just knows maybe there's a chance he can get
find some hope from another network of caring people. Maybe he's worked out
that going outside the normal system will mean getting lifesaving help
quicker. What's the political motive there?"

There was a long pause at the other end of the line. I
thought maybe I'd made the point.

Not so lucky.

Clearly calling from the bottom of a
hermetically-sealed box, the voice on the phone said, "Maybe he's just
trying to embarrass us politically by taking his request to another
country."

Or maybe he's just trying to find a source for crates
of Ensure to feed the elderly residents who decided to weather the storm in
their home, or maybe he's trying to arrange for a couple of hundred of extra
blankets to be sent his way because the power might not get fixed for two
more cold weeks, or maybe it's the family with a special needs child who
need extra medical supplies...

Maybe he has embraced his new environment and
determined he needs to take bold decisive action to survive. Perhaps he has
decided to run towards the rescuers.

___

Newsflash: Your constituents will, no doubt, take
notice when you make a big deal of attempting to halt the flow of help, new
ideas, the exchange of lessons learned, or the swapping of stories. It has
been my experience that there is no more powerful endorsement of someone
offering to help than trying to prevent them from doing so.

Everyone talks about
‘creating a culture of emergency preparedness’ but no one talks about what
the key elements are when creating any culture. How do we design a culture
of preparedness to be used as a safety anchor for people to grasp onto when
threatened?

If we’re trying to get
people to understand that the ‘cavalry’ is not going to come riding over the
crest of the hill to save them from most disasters – what are the visible
attributes of culture – do we use artifacts [a rooftop with SOS spelled out
on it perhaps], stories [Katrina, Ike, Greensburg KS, 9/11], rituals [the
annual packing and unpacking of the ‘Go Bag’], symbols, beliefs, attitudes,
rules and heroes?

In an age of fragmented
views and diametrically opposed priorities – even among professional
associations, advocacy groups, and govt agencies in the same space - who is
setting the agenda for creating this culture of emergency preparedness?

Please don’t diss the
query with a reply of ‘That’s the million dollar question, isn’t it?’ or
something along those lines. How do we take this concept forward – without
playing the blame game and talking about past failures.

So what’s your ‘wish
list’ – your priorities, your plan, your roadmap? What are you reaching for
– is there a list of tangible ‘things’ that will make this work? What are
the things – the three things that I can do – that will really make a
difference?

What was it that RFK said
about the danger of expediency – “of those who say that hopes and beliefs
must bend before immediate necessities. Of course if we must act effectively
we must deal with the world as it is. We must get things done.”

The following videos are in
French - they are from news coverage of the 1999 Ice Storm Disaster that
affected a huge swath of Ontario, Quebec, New York, Vermont, New Hampshire
and Maine. You don't need to understand French to realize that events like
this are re-shaping our personal views of preparedness.

The National
Emergency Management Resource Center [NEMRC] continues to deal with the
aftermath of Hurricane Ike. On a ‘normal’ day, we would be engaged with
government, NPOs and corporations seeking to improve their emergency
preparedness and response with respect to the most vulnerable segments
of society. Post-Ike we have employed our ability to create meaningful
networks of ideas, people, organizations and corporations to benefit
both the victims and those trying to provide assistance.

After speaking with disparate points in our web of
contacts on the ground in Texas, I am struck by the impact Ike has made
on peoples’ lives. When asked what would be highest on a ‘wish list’ of
supplies or services, each of them immediately mentioned anything that
would restore basic human dignity to the victims’ lives. I’ve always
believed you can gauge the impact of a disaster on the victims by their
wants and needs – Hurricane Ike has rocked people far back on their
heels.

And so the ‘wish list’ is striking in terms of its
simplicity. In terms of ‘things’ – there is an immediate need for phone
cards, gas cards, and CVS cards – and durable medical equipment [DME].
However, it is important to note that while there is a need expressed
for durable medical equipment, there isn’t an assurance of a secure
place for storage, nor the means to manage the collection and
distribution of DME.*
So, if there’s available cash to be spent, phone cards, gas cards, CVS
cards – and well, cash -- would be the priority – especially for local
organizations who have stepped into the breach to provide on-the-street
assistance.

In terms of
‘service’, one of the greatest concerns is what happens when the
national response organizations cede their places and move back to their
readiness positions – leaving the local organizations to not only fill
the enormous vacuum but also to find a way to allow the victims to get
on with the rest of their lives. That portion of the post-disaster
timeline is often marked by impossible expectations and overwhelmed
local resources.

High on the ‘wish
list’ would be if the Federal government were to commit funds to
establish a program of mentorship for local resources engaged with the
vulnerable population that would enable those organizations to better be
able to achieve mission success. These organizations, many of them
grassroots, are often over-committed to serving their constituents [for
lack of other resources] and have not had the opportunity to consider
rapid changes in their operating landscape. They are unable to rapidly
reposition themselves for the future – and more importantly, they often
are unable to effectively regroup in time for the next major crisis.

Local organizations
form the backbone of specialized services for people who are most
vulnerable. A NEMRC programaimed at strengthening/managing human capital through an ongoing
mentorship program already exists and we know it works in non-disaster
times. If applied here and now, this type of mentorship would create
lasting impact – and I believe a future-facing sustainable strategy will
be essential post-Ike. We are three years post-Katrina and still trying
to find the working formula for ‘getting on with the rest of their
lives’ for members of the special needs population.

*We
understand that
Portlight Strategies, Inc.
– based in Charleston SC – has made arrangements for shipping, storage
and distribution of an extensive inventory of DME for people with
disabilities in Houston in the aftermath of Hurricane Ike.

FEMA/Harris County/City of Houston evacuated all special needs residents in
those zip codes that were part of the mandatory evacuation zones. They
thought that’s where Ike would hit hardest. So they didn’t plan on any other
special needs evacuees.

Unfortunately, Ike hit the rest of Houston and surrounding area and took out
the electrical grid, the phone grid, the water system, the cell towers, etc.

An instant and cascading special needs ‘vulnerable population’ layer has
evolved – which I believe may number in the thousands. Do the math – there
are 4.1M people who live in Houston. From my experience, I’d estimate more
than 250,000 with special needs, vulnerable, medically fragile [and that’s a
very conservative number].

That ‘layer’ will continue to grow because of the cascading effects of
rationed access to healthcare resources, i.e., I have received reports
through the network of people running low on essential supplies. I suggest
you might want to read Tyson Macaulay's new book on 'Critical
Infrastructure' - it's an excellent study on the
interdependencies of much of what we take for granted.

There are now nine shelters in Harris County – and three of those are
faith-based which have been stood-up in recent hours. Total capacity for all
those shelters is 3450. Unfortunately, the faith-based churches are ‘off the
grid’ when it comes to getting a population count. [We had a similar
experience with Katrina]. The good news is that three hours ago, there were
only two ‘official’ shelters in Houston.

Of the nine shelters in Harris County, five of them are in Houston – and
three of those are in churches. The two official shelters are running at
near capacity. Total capacity of the additional three church shelters is
400.

Additionally there are church shelters in Baytown [Harris County], and one
each in La Porte and Pasadena.

We have been able to reach out to Clear Channel Radio Network to get the
word out about the additional shelters. Thanks to Ben S. for that piece of
networking. Of course, this has been an early ad-hoc effort. We’ll need to
get some high-end buy-in to make this that more effective.

How do you change perspectives - the collective mindset - of people who have
not been raised with the expectation they will one day encounter a tornado
or waterspout?

Let me explain. Up until this week, the usual number of funnel clouds,
tornadoes, and waterspouts spotted in Quebec [a massive territory - roughly
seven times the size of the UK] during the course of a summer could be
counted on one hand.

In the past several days, there have been funnel clouds, waterspouts and
tornadoes spawned from a series of severe thunderstorms - some of which
rapidly evolve over urban and suburban areas. Fortunately, there have been
no injuries and very little damage reported.

Earlier this week, while discussing the latest event - a rare waterspout -
this one came very close to striking structures and ships in the Port of
Montreal - the meteorologists on Meteo Media [the local weather channel]
were encouraging their viewers to get their cameras ready in case they
encountered severe weather and then send their pictures to the TV station.
Any dangers posed by the tornadoes
and waterspouts were downplayed entirely.

It's an interesting problem. I read and listen, in fascination, as my
colleagues in the United States debate about how to best warn people about
incoming wicked weather. And that's in areas that have a longstanding
tradition of dealing with tornadoes. How do you get people to prepare, to
pay attention to the dangers - how do you even warn them of the danger - in
a region where the weather is clearly changing?

The mere mention of the word 'ice storm' strikes fear into every
Quebecois' heart - and for that reason, meteorologists are loathe to
describe a simple freezing rain event as an 'ice storm' unless there is a
likelihood of serious ice accumulations over several days.

'Ice storm' has become part of our culture here, classified under 'scary
things that you need to prepare for.'

Tornadoes, on the other hand, are something we watch on Discovery or TLC
- they're wild and exotic and until one of them actually smacks into a
building of substance, it will be difficult to sway that notion.

"I think this scenario is something we're all going to have to be dealing
with over the next few decades. Communicating a sense of risk when we have a
real history to point at is far easier than pointing out emerging hazards,"
said Bob
Roberts, a
senior disaster planner with R.D.
Flanagan & Associates, a land/water resource consultancy
firm based in Tulsa, Oklahoma.

"We work with a similar problem as we try to
craft safety messages for immigrant populations. Their perspective on
various disasters is based on their history in another location in the
world. So one of my questions to the leadership in the Hispanic,
Vietnamese, Hmong, Russian, African, etc. immigrant population is "what
hazard most terrifies a new immigrant from your country?"

"Vietnamese, for example, are very familiar with flooding, so you may
move directly into what actions to take during a flood in this part of
the world. Tornadoes, on the other hand, may be frightening to them far
out of perspective to the actual risk. And they may see tornadoes as
something so overwhelming that there's no defense. It's just not an
animal that's in their collective mythos. So all tornado safety has to
begin with background facts and attitudinal education, before moving
into "response skills."

There have been
changes – and that’s in just a couple of days. Weather Canada has begun
including the risk of tornadoes in severe thunderstorm watches and
warnings, complete with an explanation of funnel clouds and waterspouts.

The media have
stopped telling people to run into their yards with cameras in favor of
heading into the lowest part of their house with a radio, flashlight –
and reminding them they should have an
emergency kit.

Our twin nine-year-old daughters are asking
important questions
– How much warning will we have? What should we do with the cats? If the
weather people don’t give an alert how will we know it’s coming? Is
there something I should be looking for in the sky that will tell me
that the thunderstorm is worse than usual?

The intense and
severe weather continues - there have been a series of funnel clouds, a
couple of reported touchdowns, another waterspout – and lots and lots of
severe storms in a corridor stretching from Windsor all the way
through to Quebec City [roughly 1150 km].

We had a winter that
was off that charts for snow accumulation and resulted in deaths and
injuries as buildings and homes collapsed under the weight of the snow
and ice. Now we’ve got a summer for the record books in terms of active
weather. It’s definitely not weather as usual anymore.

I've been working on the concept of 'network equity'. To further fuel my
fire of fascination, I sent the following questions out to friends,
colleagues, and complete strangers.

- What are your thoughts on the concept of 'network equity' ?
- Can an individual/organization continue to 'draw down' on a
peer/professional/social network without making regular 'deposits' or
'connections'?
- What are the likely consequences of being overdrawn on your network equity
account?

Many of the replies I have received thus far suggest a healthy network
should be built upon a platform of something for something - quid pro quo -
"one of the 'implicit' expectations of engaging in networking is some
meaningful form of 'reciprocity.'"

I reject that notion and embrace the opinion of old friend and one-time
fellow paramedic, Allan Katz, who wrote that the best kind of networking was
exemplified by the late great Time Russert. 'As executive producer Betsy
Fischer said, "He always said the best exercise for the human heart was to
bend down and pick someone else up."

I believe that the best
networks are the ones built on the premise that dots shouldn’t be connected
just for the sake of creating a connection. However, when there's an idea,
concept, organization or corporation that just needs to be connected and you
are the person who can facilitate or choreograph that relationship – well
that's certainly the magic that keeps the karma radio on the right
frequency.

I smile as I write this with the realization that there can be no standard
for what is meaningful in terms of creating a connection. No easy
convenience of 'create a connection to gain 5 credits' or 'this connection
will cost you 5 points.' No guarantee of success because often, at the point
of making the connection, the end state is nebulous.

Paul Penn, of
Enmagine
Inc. wrote 'Not all contributions are of equal merit. Many
speak volumes but with little content or substance. (Das bloviators...).
Others are meager with their contributions, but their minimalism, if
substantive and timely, may have a greater effect.'

And sometimes, pretty infrequently - okay maybe once in a lifetime, quid pro
quo involves the forceful removal of a meatball from someone's airway.

Thirty years ago, only weeks after being introduced into our
social/professional network of paramedics, a young man named Howard Levinson
recognized an emergency when everyone else thought it was just another
firehouse joke.

He quickly performed the Heimlich and the choking paramedic went on to live
a wondrous life.

Every time I hold hands with my wife, Dianne, and watch as our children Emma
and Sophie play together, I remember Howard Levinson and how one meaningful
connection may have altered fate.

Ellen Naylor, of The
Business Intelligence Source, Inc., wrote this wonderful
passage as part of her reply and I think it's a perfect way to close this
first pass on network equity:

"Paraphrasing a bit, you are helped because you help others: no strings
attached. Instead of focusing on self-interest, you are seeking the common
good. Like a boomerang, the help we give comes back to us, though often in a
roundabout way."

The call from my
sister’s cell phone came in just before one o’clock this afternoon,
“I’ve got a bit of problem… my phone’s battery is low… I’m not sure
exactly where I am… I’m with Trigger [her dog]… he fell down a cliff and
I went down to see if I could help him and now we’re both stuck down
here…”

Sue was amazingly calm. Wow. She kept her wits
about her and definitely set the tone for the way the experience
unfolded.

Not exactly how I
had planned my afternoon. Quickly ascertained where they had headed out
for their walk but couldn’t remember any cliffs or even embankments in
the area. Sue was okay. Trigger wasn’t doing so well – he couldn’t move.
Told Sue to sit tight and began heading in their direction.

Called a friend who
is a Division Chief with the FD and told him what was going on. He said
he’d standby until I had a better fix for a location. Stopped at the
local firehouse [the same firehouse where I had started my career more
than 30 years ago] and explained to the Captain what was going on. He
said they’d have a rig and crew follow me out.

When I got to where
I thought Sue and Trigger might be I yelled out my sister’s name. I
heard her reply but her voice seemed to be coming from somewhere far
below. It was astounding. I walked forward past the edge of the treeline
and looked down about 35-40 feet. Sue and Trigger. There was no way I’d
be able to make it down and back up and out with both my sister and her
dog without a line or two.

The firecrew arrived
a few moments later. Long story short: Nice job by professional rescuers
and both Sue and Trigger were brought topside safely. Took Trigger to
the vet and we’re in wait-and-see mode now hoping he’ll make a full
recovery.

A nod of respect and thanks to the
firefighters of Station 77 of the Montreal Fire Department.

News item: 'Group fights park closures as Sunday
deadline nears' - The Advocate/WBRZ News, New Orleans LA May 30 08 “I am concerned that the number of homeless in
this region will grow,’’ Bishop Charles Jenkins of the Episcopal Diocese of
Louisiana said Thursday. Jenkins said the current “crisis’’ is not just
about trailers, but the dignity of every human being.

___

Perhaps it's finally time to begin using the word 'refugees' to describe
some of the victims of Hurricane Katrina.

In the days immediately following Katrina, news
outlets debated the use of the word 'refugee' to describe the victims of the
hurricane.

Quoted in an NPR piece of Sept 5, 2005, civil
rights activist Al Sharpton said, "They are not refugees. They are citizens
of the United States." In the NPR piece, journalist Mike Pesca went on to
write 'Sharpton's point was that it strips a person of dignity.'

Almost three years post-Katrina, I believe it's safe to say the dignity has
been stripped from the lives of many hurricane victims in much the same way
as irresponsible campers strip the bark from birch trees to start their
campfires. They leave the trees still standing but susceptible to the
ravages of disease and the seasons.

A total of 17,000 families are still left in trailers in Louisiana. In
Mississippi, there are approximately 7500 families still in the FEMA
trailers.

Those would be the same trailers the CDC recommended - back in February -
that should be evacuated as soon as possible due to concerns over
formaldehyde.

It's all fairly abstract - like driving in a big old Chrysler Imperial and
having a fender-bender crash. You know it happened out there but it really
doesn't affect you in here. Katrina seems like such a long time ago and
haven't there been a string of other near-apocalyptic disasters and can't we
just stop talking about what happened down there on the Gulf Coast?

The news cameras only visit occasionally now. I read somewhere that the Pass
Christian Yacht Club finally re-opened three summers after Katrina
obliterated the club and the town around it. When I went to Mississippi, I
remember trying to describe what remained of Pass Christian and other towns
that sat along the coast. The only thing I could come up with was 'Imagine a
beaver dam. Now imagine the beaver dam is fifteen feet high and several
miles wide."

There are still thousands of people who live in trailers provided by FEMA
who just cannot afford to re-establish their pre-Katrina lives in a
meaningful manner. They really can't go home in any way that will ever
reconstitute the life they had before the 'worst natural disaster the United
States has faced in modern history.'

The media debate over the term 'refugees' was centered on whether or not its
use somehow implied they were 'second-class citizens' or worse - perhaps not
even Americans.

And now nearly three years after Katrina roared ashore, how else would you
describe these people who escaped into the storm with nothing more than the
clothes they were wearing, were forced to live in sub-standard housing often
in unfamiliar places, and were provided with impersonal government
agency-centric scaffolding to support them?

Perhaps FEMA isn't the best agency to handle transitioning thousands of
people from a 'temporary existence' in a trailer to being able to put down
roots again in affordable, accessible housing.

Still recovering as an organization and continually preparing for the next
hurricane catastrophe, FEMA seems an unlikely choice to provide the
additional support necessary to assist seniors, special needs residents and
the working poor to be able to re-establish their lives in a meaningful
manner.

Political candidates take note:
It’s always more
difficult to do the ‘hard right thing’ when faced with a dilemma. The ‘hard
right thing’ to do is to take care of the people still living in those
trailers. Not to try and stickhandle through the accountability pylons in
the hopes of scoring political points.

The Katrina refugees need to have their faith restored
in America. So does the rest of America.

Cynthia is nine years old. She was rescued from her home after floodwaters
reached the second floor. Her mom and dad and sister and their two cats all
made it out safely.

However, right at this moment, in the middle of an overcrowded Red Cross
shelter, among hundreds of other evacuees, the only thing that matters to
Cynthia is that her bed socks were left in the top drawer of the dresser in
her bedroom.

Cynthia has Obsessive Compulsive Disorder [OCD]. Every single night she
takes a shower just before bed, then brushes her hair, brushes her teeth,
puts on her PJs, then stops at the top drawer of the dresser in her bedroom
and selects a pair of bed socks for the night.

She only wears those bed socks in bed. If she needs to get up to go to the
bathroom in the middle of the night, Cynthia will pause in order to remove
her bed socks before stepping down out of bed.

According to the rules set forth in Cynthia's OCD ritual, those socks cannot
touch the floor and will be switched for another wear-anywhere-pair in the
morning.

Cynthia's bed socks are not here in the shelter. They are back there,
somewhere, in the house in the middle of the floodwaters. Knowing that there
is no way to retrieve her bed socks comes the realization she will have to
confront her OCD ritual without any assurance of a positive outcome.

Cynthia begins to scream. Not a silent-open-mouth cry of frustration but a
hair-standing-up-on-the-back-of-your-neck full-body scream that rises in
pitch until everyone in the shelter is painfully aware of the anguish of one
little girl whose bed socks are missing, presumed drowned.

She will not be consoled. For more than an hour Cynthia screams and cries
before exhaustion finally overcomes the little girl and she falls asleep.

Just a thought for all of you tasked with organizing shelters from the
storm[s]. A child battling OCD rituals will likely have difficulty with
disruptions to her routine. Even transitional times from one routine to
another can be extremely challenging. The complete disruption of routine can
be devastating.

"I have been plagued by OCD stuff since late childhood and often felt that
if I didn't do a certain pattern repetition that I would die or be
responsible for the deaths of others. Progressively I came to doubt it by
holding back and finding nothing bad happened.

"But still, as an adult, I have to hold back from straightening things or
putting them right side up just because some nutso part of me says that if I
don't then deaths will occur. It's so laughably nuts, but those who don't
have this can't imagine how that grip in one's guts really dominates reason.

"With OCD one can train oneself to not side with this stuff, not be bullied
by it." - Donna Williams interviewing Stuart Baker-Brown in the wonderful
Irked Magazine [issue #5]
available online.

Nearly 60 million [26 percent] Americans aged 18 and older suffer from a
diagnosable mental disorder. Mental disorders are the leading cause of
disability in the United States and Canada. Many people suffer from more
than one mental disorder.

Anxiety disorders include panic disorder, post-traumatic stress disorder,
generalized anxiety disorder, phobias, and obsessive-compulsive disorder.
Panic disorder usually develops in early adulthood. One-third of people with
panic disorder develop agoraphobia - an acute fear of being in any place or
situation where escape might be difficult. Obsessive-compulsive disorder
often begins during childhood.

For Cynthia, losing her socks is more frightening than a monster in the
closet. Knowing that can make all the difference in her world when a
disaster turns it all upsidedown.

: I first wrote this piece in 1998 and unfortunately we are
still no
closer to having Advanced Care [ACLS] Paramedics in Quebec.

There was a pilot paramedic program however that was met with open
hostility by several segments of the emergency healthcare spectrum - and
several million dollars later with just two new protocols tested and
adopted, the original group of 20 paramedics has shrunk to 14 and several of
those are said to be contemplating escape routes that will take them over
the wall and out of the province to where they can actually save a few
lives.

Here we are in 2008 and the situation continues to
deteriorate as the provincially-funded
Montreal EMS system has chronic issues with poor response times in the
suburban reaches of its territory. It is understaffed, under-funded, and
perhaps to no one's surprise is under-performing when it comes to crucial
issues like actually saving lives.

Mrs. Rosenberg is still dead
and there's no telling when someone, anyone, will do something to address
the way Emergency Medical Services are provided in the Province of Quebec.

What can you do to help
get Advanced Care Paramedics legalized in Quebec?

You can register either as
individual, organization, school or business and tell everyone you
deserve the best possible prehospital care available.

Email us your name, email
address, Organization name and we'll get back to you to confirm that you
are authorized to add your organization's name to the Legalize
Advanced Care Paramedics in Quebec Now

I was there when Mrs. Rosenberg died. I knew her from the five previous
times I had responded to her apartment. She had a bad heart. She didn't like
to call for help -- she'd wait until the pain was unbearable before she
dialed 911. Even after all the polite lectures I had given her about calling
right away when the pain started. Mrs. Rosenberg always said she didn't want
to disturb anyone. She was sweet but stoic.

She told me all about her three sons and seven
grandchildren. And her husband who had passed away last year. She said it
was hard to go on without him but she looked forward to each family visit.
She loved her grandkids. She showed me pictures of them - part of an
enormous collection of framed photographs she kept on her coffee table.
There they were in little league baseball uniforms and school graduation
portraits and with girlfriends and wives.

Mrs. Rosenberg always offered me a glass of
orange juice. I'd give her oxygen and check her blood pressure and her pulse
and hook her up to the cardiac monitor and she'd be sure to offer me my
juice. She was everybody’s grandmother. I was there when she died.

She dialed 911 after enduring crushing chest pain all night. She said she didn’t
want to wake anyone up. Mrs. Rosenberg was gasping for breath. She didn't
offer me any juice. I told her to hang in there as we waited for the
Urgences Sante [Montreal EMS] ambulance crew who would take her to the
hospital. I told her to think about her grandchildren and to keep on
breathing. She did her best. I gave her oxygen. I talked to her. My partner
checked her vital signs-they were terrible. We only had to look at Mrs.
Rosenberg to know she was dying.

Her electrocardiogram indicated a significant
arrhythmia. I could have established an intravenous line. But I didn't. Mrs.
Rosenberg lost consciousness a few moments later. Her breathing was ragged
and slowing down. I could have prepared an endotracheal tube to secure her
airway. But I didn't. I assisted her breathing with a bag-valve-mask. My
partner affixed the defibrillation electrodes to her chest - just in case.
We could have intervened a long time before this moment to prevent this from
happening. But we didn't.

Although I'm a paramedic and trained to
provide advanced life support care under the direction of a physician, I am
not permitted to so in the Province of Quebec. We don't have legal standing
in the province - the only jurisdiction in the G8 that has failed to
recognized advanced care paramedics. It is illegal for me to attempt to save
a life using advanced life support. Even everybody's grandmother's life.

I was there when she died. It wasn't pretty.
Urgences Sante sent a physician to assist because Mrs. Rosenberg had lapsed
into cardiorespiratory arrest. The physician arrived after we had completed
15 minutes of CPR. Unless advanced cardiac life support is initiated within
the first six to eight minutes after cardiac arrest there is almost no
chance of recovery. Such was the case for Mrs. Rosenberg.

The physician arrived, verified the
electrocardiogram, and told us to stop our resuscitation efforts. Just like
that.

Mrs. Rosenberg died on the livingroom floor in
full view of the photographs on her coffee table.

It’s been more ten years since Mrs. Rosenberg died.

I wrote about her death in the newspaper. I read about her passing on the
radio. I shared her death with thousands of people across this land.

Wherever I talked and/or taught I told folks about Mrs. Rosenberg and how
she died, gasping for breath, on the floor of her livingroom within view of
the dozens of photos of her children and grandchildren.

She died because I refused to break the law. I probably could have saved
her.

I could have inserted an endotracheal tube into her airway. I could have
established an intravenous line in her arm. I could have administered drugs
to combat the deadly arrhythmia in her heartbeat.

I don’t know for sure that Mrs. Rosenberg would have made it home again.

All I know is, like every other Advanced Care Paramedic in
Quebec, I didn’t do anything more than
the law allows.

She died.

Almost ten years have passed and Mrs. Rosenberg is
still dead.

She’s going to be dead a very long time before
paramedics are recognized as an essential part of the emergency health care
system in Quebec. We’re the only jurisdiction in North America that doesn’t
recognize advanced care paramedics as an integral component of the emergency
medical services system.

In
Quebec, we don’t have Advanced Life Support paramedics because, despite the
embrace of all things secular, when it comes to our provincial Emergency
Medical Services [EMS] system we have placed our faith in God – and the
skills of the resurrection specialists working in our hospitals' ERs.

If
God is smiling down upon you, you just might survive the ride in the
ambulance that delivers you into the hands of his emissaries in the ER.

With
one of your feet already firmly planted in death’s door, the nurses and
physicians of the ER will do their darndest to successfully pull you back
towards the light. And once you’re confirmed to be back among the ranks of
the living, there will be high-fives all around in the crash room as yet
another soul has been saved.

And
if you die, well, you died because you were destined to do so despite the
best efforts of the team waiting in the Emergency Department.

You
just cannot have an effective Advanced Life Support Emergency Medical
Services [EMS] system in a society that has bought a lifetime prescription
to the notion of supporting a monopoly on who should save lives.

In
Quebec, physicians save lives. Ambulance technicians deliver patients to the
physicians. That is the way it has always been with only a few notable
exceptions:

There were the years that Urgences Sante [Montreal & Laval’s
provincially-owned and operated ambulance service] decided the ambulance
technicians were not delivering the patients quickly enough to the
physicians so they placed physicians on the road in ‘doctor’s cars.’

That
didn’t work because there just weren’t enough physicians to answer all the
calls for critically ill/injured patients and then dispatchers found
themselves in the unfamiliar territory of having to play God and deciding
which patient deserved to be seen by a physician at the scene.

And the economics of having physicians on the road was
creating a bang-for-buck black hole. You could afford to put three ALS
paramedics on the street for what it cost to put one physician in a doctor's
car with his ambulance technician driver. And the doctors were permitted to
sign-off their shift a half-hour before it actually ended in order to ensure
they were safely back at home base just in time for their next engagement.

Remind me to tell you about the doctor who decided to
go windboarding while on-duty. He achieved near-legendary abuse-of-power
status among legions of underpaid, overworked, disrespected street medics.
But I digress. Ambulance
technicians deliver patients to the physicians, who in Quebec hold the
monopoly on saving lives and deciding on who else will be allowed to save
lives.

So,
while there are Advanced Life Support paramedics based on ambulances,
firetrucks, and helicopters everywhere else in the G8, here in Quebec,
physicians have decided ALS paramedics are just not necessary for the chain
of survival.

That’s your chain of survival, folks. To quote
Jim Duff,
“It’s the system that begins with a 911 call and ends when the hospital
moves you out of intensive care — or to the morgue.”

Now
if you live in Quebec, you’re probably thinking, ‘wait a sec – I keep
hearing the word ‘paramedic’ being used to describe ambulance technicians
these days.’ Aaah, that was one of the most cynical spin-jobs ever
successfully carried out in these parts.

Same
old basic life support-trained and equipped ambulance technicians with a new
title - and sadly for the streetmedics, a new uniform that's so ugly it has
spawned a protest group on FaceBook ['Ambulancier contre la
chemise laide']. No
kidding.

There was an Advanced Life Support paramedic pilot project in Montreal but
after several million dollars and just two new protocols tested and adopted,
the original group of 20 paramedics has shrunk to 14 and several of those
are said to be contemplating escape routes that will take them over the wall
and out of the province to where they can actually save a few lives.

Fourteen ALS paramedics out of 824 – that’s what, almost two percent of the
ambulance technicians trained to the level of Advanced Life Support. On any
given day that might mean there’s one or two ALS ambulances out there on the
road. I’m not sure who decides what calls they respond to but I suspect that
at the head of that chain-of-command you’re going to find a physician with
links to the Monopoly Head Office.

Interesting that in Ontario the approach has been decidedly different. There
are ALS paramedics right across the province.

Dr.
Ian Stiell, a senior scientist at the Ottawa Health Research Institute, and
Emergency Department physician at the Ottawa Hospital led the Ontario
Prehospital Advanced Life Support (OPALS) Study. OPALS was a controlled
clinical trial conducted in 15 cities before and after the implementation of
a program to provide paramedics with advanced life support (ALS) training on
how to help patients with out-of-hospital respiratory distress.

The
results of that study indicated that as many as 2,000 Canadians could be
saved if more paramedics were trained in ALS.

Interviewed as part of a
CTV
story reacting to the results of the study, Stiell said:
"If you want to save more lives, we need to provide advanced life measure to
any patient having trouble breathing."

In
the same
CTV
piece, former Montrealer Anthony di Monte, the Director of
the Ottawa Ambulance Service said, "This study proves that advanced care
paramedics can make an important difference for those suffering from
life-threatening respiratory difficulties."

Perhaps one day soon we will begin placing our faith in the people who have
the wisdom, experience and courage to work the frontlines of emergency
medical services instead of having them continue to serve as the pick-up and
delivery service for the ERs.

In
the meantime, you can try praying for a miracle.

There should never be a monopoly on saving lives or helping people in an
extraordinarily difficult moment of their lives.

In Cote Saint-Luc, residents pay taxes to both their city
and to the City of Montreal. The share paid to the City of Montreal includes
the amount required to pay for fire services, which everywhere else on the
Island of Montreal, also includes medical first response services.

Not so in Cote Saint-Luc. The City has decided it's all or
nothing when it comes to providing emergency medical services for their
residents. So, if Cote Saint-Luc EMS is not available to respond, the
Montreal Fire Department is not permitted to send their trained firefighters
to possibly save a life before an Urgences Sante ambulance crew arrives.

All or, literally, nothing. Taxation without resuscitation.

As I understand the breakdown of the Cote Saint-Luc tax
bill, four cents of every dollar goes to pay for EMS and Public Security.
The bill sent by the City of Cote Saint-Luc to the Agglomeration Council for
services rendered by EMS was for $553,000. That's for one station serving
31,395 people.

If the Montreal Fire Department required $553,000 for each
of its 66 stations, the bill to provide medical first response by
firefighters would be almost $36M per year.

Instead, the cost of the Montreal Fire Department program
which, by the end of 2008, will serve residents in the following boroughs
and municipalities, is estimated to be in
the $7M to $10M range.

Villeray-Saint-Michel-Parc Extension [pop. 142,825]

Rosemont-La Petite-Patrie [pop. 133,618]

Mercier-Hochelaga-Maisonneuve [pop. 129,110]

Ahuntsic-Cartierville [pop. 126,607]

Riviere-des-Prairies-Pointe-aux-Trembles [pop. 105,372]

Plateau-Mont-Royal [pop. 101,054]

Saint-Laurent [pop. 84,833]

Montreal North [pop. 83,911]

LaSalle [pop. 74,763]

Saint-Leonard [pop. 71,730]

Pierrefonds-Roxboro [pop. 65,041]

Dollard-Des-Ormeaux [pop. 48,930]

Lachine [pop. 41,391]

Anjou [pop. 40,891]

Pointe-Claire [pop. 30,161]

Outremont [pop. 22,897]

Westmount [pop. 20,494]

Kirkland [pop. 20,491]

Beaconsfield [pop. 19,194]

Mont-Royal [pop. 18,933]

Dorval [pop. 18,088]

Ile-Bizard-Sainte-Genevieve [pop. 17,590]

Hampstead [pop. 6,996]

Sainte-Anne-de-Bellevue [pop. 5,197]

Montreal West [pop. 5,184]

Baie-D'Urfe [pop. 3,902]

Montreal East [pop. 3,822]

That works out to roughly $150,000 per station in the
Montreal Fire Department. And that includes costs for vehicle replacement
and depreciation due to the increased wear and tear that comes with a higher
call volume.

The Montreal Fire Department
emergency medical first response system makes sense. It makes sense in terms
of consistently getting trained first responders to people in urgent need in
a meaningful amount of time. It makes sense in terms of providing serious
bang for taxpayers' bucks.

And ultimately, it makes sense
to blanket the entire city with an effective way to save peoples' lives on a
round-the-clock 365-days-a-year basis.

. . .

The "they said-we said ads"
about response time are not bringing real 24/7 emergency medical response
any closer to being a reality in Cote Saint-Luc.

There should never be a monopoly
on saving lives or helping people in an extraordinarily difficult moment of
their lives.

I am stubborn. My wife warned me not to try and change that
lightbulb on my own. She told me I ought to ask our neighbour from
across the street to lend me a hand. I waited for her to go over to
one of her friends for tea and muffins and then I decided to give it
a go.

"I have fallen and I cannot get up," I said in slow and determined
fashion to the emergency operator who answered the call I placed to
911. I remembered that series of television ads and winced at the
realization I had just used the same line to call for help.

"No, I am not having any difficulty breathing. Yes, I hit my head
but no, I did not lose consciousness. No, my neck doesn't hurt. No,
no chest pain to speak of. Yes, I do have some terrible pain in my
hips. I am 81-years-old. No, I do not take any prescription
medications of any kind. No, I am unable to get up on my own. The
pain in my hips is quite intense and it gets worse when I try to
move.

"Yes, I understand there might be a lengthy delay before the
ambulance gets here. I know it's very cold outside and I understand
you must be very busy. I would not have called if I could get up on
my own. I fear I have injured my hip otherwise I would not be
calling for help.

"Pardon me for asking but I thought we had first responders in our
town who might be able to help me before the ambulance crew is
available. Oh, I see. They only respond to higher priority calls.
Well, I do understand. I will do my best to stay comfortable until
the ambulance crew arrives. Yes, I will certainly call you back if
anything changes or I feel worse in any way."

The light of the afternoon faded into the early darkness of a winter
evening and the ceramic tile floor quickly lost any of the heat it
had retained. I struck up a conversation with the cat but the cat
lost interest and walked away. I watched the time on the microwave
clock move slowly minute by minute. I fought the urge to pee.

I concentrated on looking at the photographs of our children and
grandchildren we had proudly hung on the livingroom wall. I couldn't
remember the phone number at my wife's friend's house. I wanted to
cry.

I couldn't believe that I was all alone, had called for help, and no
one was on their way yet. I wondered what level of priority my call
for help was for that first responder team.

Were they only concerned about life and death? Were they so busy
they could not even spare a moment to check on a resident of the
community who had confirmed he was in a spot of trouble?

Had they no idea how important it was to provide a physical presence
for someone in a time of extraordinary need?

And so, I lay alone on the kitchen floor with a badly bruised hip
for more than forty minutes before the ambulance crew and my anxious
and bewildered wife arrived simultaneously.

___

Right. The preceding was just me, Hal Newman, trying to imagine what
it would be like to be all alone and waiting for emergency medical
assistance after having been classified as a priority Two or Three
call on a day chockfull of priority One calls.

Calls of every priority should be responded to and not only by an
ambulance crew.

Actually, I believe it would be rather interesting to have a first
response team specially trained to respond to calls of a lower
priority to determine whether or not those patients actually need to
be attended to by the much scarcer ambulance-based paramedics.

There should never be a monopoly on saving lives or helping people
in an extraordinarily difficult moment of their lives.

The clock begins ticking when someone calls for help. The primary
consideration should be who can get there quickest to render aid -
not which response organization has a 'claim' to the territory.

It's not about what uniform the responder is wearing. Every EMS
organization should take an enormous leap of faith forward, work
with all of the stakeholders and establish a model that ensures
everyone in the community gets the EMS they deserve.

On average, when someone suffers sudden cardiac arrest, irreparable
brain damage occurs within four to six minutes.

On average, the time between recognition of a life-threatening event
and the arrival of a trained and equipped emergency medical
responder is more than eight minutes.

Do the math.

I guess that until you save someone’s life with an automatic
external defibrillator [AED], it is hard to grasp the incredibly
positive impact these devices can have. I know first-hand what it is
like to use an AED to save another person’s life.

A 50-year-old woman had collapsed at the office. Her colleagues had
recently been certified in CPR as part of a workplace safety
initiative. They immediately called 911 and began cardiopulmonary
resuscitation.

I was part of the first response team that arrived at the woman’s
side a few minutes later. We were equipped with an AED. The machine
functioned perfectly and after the second shock was delivered, we
could feel the patient’s pulse.

By the time she was loaded into the ambulance, the woman was
breathing on her own. After several days in the hospital, she went
home to her family.

A little more than a year later, I received a card from the woman
and her family thanking me for giving her a “second chance at life.”
The card contained a photograph of her entire family gathered
together for a special birthday celebration on the date we had used
the AED to save her life.

I will always remember that card because it described all the family
celebrations she was able to attend and all the people who had been
touched because her life had been saved. The card ended with a quote
that said “to save one life is to save a universe.”

Can you imagine how much safer it would be if every office building,
arena, bank branch, place of worship, school and shopping mall had
automatic external defibrillators readily available?

I’m not in the business of selling defibrillators. I just know how
effective they are and I believe they ought to be right below the
smoke detector and right next to the fire extinguisher on as many
walls as possible.

Whenever someone tries to tell me it’s not worth the effort, I tell
them the very same Second Birthday story I just shared here. There
is no downside to working together to try to save as many lives as
we can with a well-proven, easy-to-use, and relatively inexpensive
tool.

Be well. Practice big medicine.

___

And here's an
interesting story about being able to afford to implement AEDs on a
much greater scale:

My firm, TEMS, is
working with Macquarie Technology Finance to create innovative programs
for specialist IT leasing, asset finance and asset management solutions
for a wide-range of technology-based equipment.

A leading
professional services firm sought to equip its offices with Automatic External Defibrillators [AEDs]
as a workplace safety measure for its employees. The firm planned to
deploy the units throughout its offices and train staff to use them in
case of emergency. The AEDs came with a 48-month warranty and given the
expected changes in technology, the firm planned to replace the
defibrillators with new ones at that time.

With this plan in
mind, the firm decided to lease-to-return the AEDs with Macquarie
Technology Finance rather than purchase them outright.

That decision had
many benefits: the defibrillators will be kept evergreen because they
will be replaced with the best possible technology at a set point in the
future; Macquarie provides a recycle channel for the AEDs [defibs with
significant useful life will continue to save lives beyond the end of
the term]; and the firm profited from the residual investment made by
Macquarie as part of the lease agreement thereby reducing the total cost
of ownership.

The professional
services firm was able to match the costs, including the training and
service costs, to the useful life of the defibrillators in the form of
periodic rentals as opposed to an upfront cost. They minimized the cost
of ownership and got the AEDs into the places where they were needed.

Too crass to mention this because my firm is part of the equation. Yeah
maybe it is. However I'm tired of hearing that it's too expensive to
implement AEDs across the board. Here's a workable solution. I'd rather
get creative and see more defibs out there than not risk offending
someone's sensibilities.

If you want more information on keeping your lifesaving technology
evergreen, drop me a line at hnewman@tems.ca

It’s a complex and
emotional issue however I’m concerned that folks are allowing the
political fog to obscure the bottom-line. And that’s a bottom-line that
has plagued prehospital emergency care in Quebec for decades: There should be no monopoly on saving
lives.

CSL EMS is a unique
service because of the team of volunteer EMS providers who have lent
their hearts and souls to the organization over the years. It has always
been about taking care of the members of the community as if they were
members of your own family.

However, CSL EMS is
a volunteer-based department which implies occasional downtime due to
limited resources, be they human resources or equipment or vehicles.
That’s a fact of life in emergency services.

One need only
examine Urgences Sante – a career-based service facing resource crunches
of its own.

CSL EMS and the
Montreal Fire Department should come to an agreement that would see
firefighter first responders taking the place of CSL EMS when the
service is unavailable, e.g. a missed shift [and that does occur despite
what some people might say] or simply because there are multiple
simultaneous calls in the district.

Despite all the news
about pressure tactics, the Fire Department has not experienced any
interruption of first response service. The training and implementation
plan that began in April of 2007 remains on-track. The idea is to offer
firefighter first response all across Montreal. And that’s what’s key:
to get the care to the people who need it most in a timely fashion.

The Fire Dept will
only be responding to Priority 1 calls. CSL EMS should petition the govt
and Urgences Sante to respond to all calls for assistance from within
the community, no matter what the priority. Sometimes the single best
thing you can do for someone is to be with them in a difficult moment of
their life.

As a father of twin
eight-and-a-half-year-old girls, I can tell you that when we called for
help because one of our daughters was in respiratory distress and the
firefighter first responders arrived from the Pointe Claire station – I
wasn’t concerned about what uniform they were wearing or what colour
truck they were driving. All we were worried about was our little girl.
And so were they. And that’s what it’s all about.

Again, the bottom
line: There should be no monopoly on saving lives.

Next week, I'll be
examining why Quebec doesn't yet have a full-fledged advanced care
paramedic program. And yes, you might have guessed - it relates to a
willingness to maintain a monopoly on saving some of the lives some of
the time.

I am taking horse handling lessons so that I can participate in the
whole horse love affair that Di and the kids have going on.

I don’t want to ride so I thought it would be useful to become
comfortable with handling the big beasties.

Wednesday morning provided a tangible reminder of why it’s
incredibly important never to lose concentration even for just a
second while handling a horse.

I was bringing a four-year-old big guy named [no kidding] Nixon out
of the paddocks to go back to the stable and I made the cardinal sin
of allowing Nixon [I’ve taken to calling him ‘Dick’] to get slightly
ahead of me on the incline down to the stables.

I saw him look at me and knew what was coming even before his
hindquarters came around hard and caught me right on the hip.

I was intelligent enough to let go of the lead line and so I managed
to get some really good air before landing on my side a few metres
away. Christian - my instructor and the owner of the Centre Equestre
Le Club [in Vaudreuil 450-458-2769] said that when he saw me I was
still in the air and gaining altitude.

I believe that if my shoes were not tied on as well as they were
they would have stayed on the path right where Dick hit me -- just
like the shoes I used to find at the point of impact at a pedestrian
v car scene.

I got right back up because I didn’t want Dick to think he could
toss me around like that [like who am I kidding?] and led him back
into the stables without further incident.

I continued with my chores – mucking the stalls, hauling hay bales
and shavings, doing the feed rounds and then when I finished my
morning and sat down in the van I realized my whole right side was
hurting.

Popped a few advils and went to bed and awakened the next morning
feeling as if a truck had hit me on the hip and butt. At age 47, I
just don’t have the same bounceback as I did when I was younger.

But other than the feeling that Nixon somehow came back as a horse
and kicked my ass, I’m just fine and looking forward to Saturday
afternoon at the stables.

I bought a poppy this morning and pinned it to my baseball cap. Too
early in the season for some I've been told. Much too late for
others I know.

The ghost battalion of street medics. Death by stress, suicide, or
misadventure. Casualties of battles fought on the road and in their
heads. Demons picked-up along the way like black-spirited hijackers
waiting for a time to take control.

Politically incorrect to imagine direct links between sudden
unexpected death and life wearing the caduceus on your collar or
tattooed on your shoulder.

Yesterday I received news that a young firefighter/medic had taken
his own life. Another gatekeeper of the cracks who somehow managed
to slip into the abyss that exists in the shadows between the ranks
of fellow EMS providers.

'He was a gentle soul who was genuinely caring and a real pleasure
to work with'... and he was practiced in the art of self-isolation
enough to drift in ethereal misery until he finally capped his own
existence.

----

Jamie Flanz was murdered two springs ago. His passing had no
connection to the EMS world other than the fact that his obvious
state of death probably didn't require a streetmedic to declare the
absence of life signs.

He was a good medic and was a gentle, reassuring presence with many
of our most senior patients. He put in many a shift at the last
minute because I called and asked for his help.

It is the transient and intense nature of EMS that lifesavers often
come and go without much in the way of heralding their arrival or
their departure. They touch lives and impact universes and then they
move on to live the rest of their lives.

There are, apparently, no guarantees on how long the rest of their
lives will be. Maybe some of them have an inkling of sunset rapidly
approaching and decide to go out flaming while others simply pull
the bedcovers up over their heads.

----

Almost a decade ago, I responded as
back-up to a call for a 50-year-old patient in cardiac arrest. While rolling
I thought I heard the dispatcher say the patient had been found with a
plastic bag over her head. I remember thinking to myself “that can’t be
right.” The dispatcher didn’t repeat the message and I thought it was
because the medic crew was thinking the same thing I was and didn’t question
the information provided.

I rolled onto the scene just a few moments after the crew and followed the
sound of their voices into the apartment. I passed a somber group of folks
gathered in the hallway around the front door. “They’re in there,” a
middle-aged man with an L.L. Bean lumberjack-style shirt and a tear-stained
face said to me. Heard Jen tell Boris, “No how. No way. EMS1 will be in here
in a sec to confirm.” Then to Dispatch, “We’re going to need the police
here. Cancel the ambo crew.”

I walked into a bedroom to find the crew looking at the body of a
fifty-something-year-old woman recently deceased. She was dressed in stylish
pyjamas and was wearing matching sleeping covers over her eyes. Her fingers
were blue and her hands were frozen in mid-air as if she had shaken hands
with Death when he had arrived. There was a plastic bag covering her
hair—crinkled and crumpled and standing straight up like some macabre white
plastic chef’s hat. There was an empty bottle of vodka next to the bed and
several empty pill bottles scattered among the bed covers. Two sealed
envelopes had been found by her brother (the L.L. Bean shirt) who had
discovered the scene and had pulled the bag from her face before calling
911.

We sealed the apartment. Shooed the brother and the building manager and the
guy from the apartment across the hall out of there. We waited on the police
officers who took our report and then asked us to wait outside. They emerged
a few moments later with some of the dead person’s identification. “Her name
was ------ …” There seemed to be a wave of air that came out of nowhere and
hit me right in the gut. I felt an enormous weight slam into my shoulders
that forced me down to my knees. I heard myself mutter, “Sweet Jesus.” And
then I was kneeling on the carpet in the corridor fighting the urge to hurl
vomit and bile out of my mouth.

Jen and Boris were by my side in a heartbeat. “Hal, are you all right?!” I
was unable to answer at first—too intent on listening to all of the air rush
out of my lungs through my clenched teeth. “Yeah. I’m okay.” Wrong answer. I
tried to get back up to my feet but my sense of balance had been thrown into
temporary disarray. “OhmyGod. I just spoke to her on Friday afternoon.”

She was a colleague of mine—an experienced emergency care provider who
worked for a parallel health care organization. We interacted on a regular
basis and had forged a strong bond during the Montreal Ice Storm Disaster of
1998. I had seen her practicing the art of caring with elderly clients
forced into a shelter by the combination of darkness, cold, and ice. She had
been particularly effective with the Holocaust survivors who had retreated
into some tormented memories none of us could penetrate. Her combination of
compassion and gutsy courage had gotten through to folks living a
nightmarish flashback of forced evacuations all those years ago.

My pager went off right then while I was struggling to regain vertical mode.
The message read, “Shall I send out a SMART alert?” (SMART is an acronym for
our Stress Management Response Team). I radioed Dispatch, “Yeah. For me.” I
was really upset that I hadn’t recognized her… as if I somehow should have
realized it was her even though I had no idea where she lived. As if one
might expect to encounter a friend dressed in her death-best outfit. It was
an irrational reaction to a surreal scene. The lead police officer came over
and asked if I was okay. “Yeah. I’ll be alright. A couple of wicked bad
dreams and I’ll be ready for the next tragic response.”

I cleared the scene and then drove over to that parallel health organization
where I broke the news to her colleagues. It was a rough scene. Naomi
Cherow, part of SMART, arrived a few minutes after me. Naomi took the lead
and walked the staff through a very tough evening of sadness, anger, and
lingering unanswerable questions.

I went home and had a couple of wicked bad dreams.

The next night I had a couple more.

Then on the third day a baby boy drank chlorox and by the time I got home I
was focused on ensuring all the methyl ethyl bad stuff in our home was
securely locked away from the prying fingers of our daughters. No more bad
dreams. Although I did have a dream wherein I saw my late colleague sleeping
peacefully on a sofa in one of the Ice Storm evacuation shelters. She was
surrounded by elderly Holocaust survivors. I could tell they were survivors
because of the numbers tattooed on their forearms. One of them said, “She’s
our angel.”

I don’t understand suicide. Never have. I can’t imagine anything that could
drive me over the threshold of the living and into the valley of the dead.
With no opportunity to hook a u-turn and head back home if the experience
didn’t pan out the way I thought it was going to go down. It must be a
torturous decision to make. I don’t know what drove my friend to the edge of
the void and then into the vast beyond of emptiness. I only hope she is at
peace wherever her soul has gone.

I have often been referred to as
a 'human lightning rod' because of a tendency to be the connector of
dots at the center of turbulence.

I beg to differ. I am the lightning man.

I have
been tracking severe thunderstorms for as long as I can remember. My
family and friends benefit from my obsession with superheated air in
the receipt of timely emailed reminders to bring in the lawn
furniture and small pets.

In all the time I have been
following lightning, it never occurred to me that maybe, just maybe,
lightning was tracking me.

Camping with my family recently
in south-central Quebec, just north of the border with Maine, I
watched the sky as the clouds began showing signs of aspiring to
develop a majestic soundtrack and an accompanying lightshow. Of
course, the weather forecast was calling for just a slight chance of
rain but I was fairly convinced we were going to see some big-time
lightning by nightfall.

We had a wonderful day on, in, or
near the lake and Di and the kids were playing Blokus on the picnic
table by lantern light when that little lightning detector in my
head started pinging. I wandered down to the lake and looked out to
the horizon. Nothing seemed particularly threatening out there and I
thought perhaps the clean country air had messed with my inner
tracking systems.

Not.

A few seconds later there was a
massive display of forked lightning that ripped across the far
skies. I tried to calculate distance but with no discernible cloud
line and no ripple of thunder it was a guess at best. I figured we
had about a half an hour before this storm was overhead.

So I began wandering around the
campsite picking up all of the items that could become projectiles
in a high wind. I took great pains not to alert the girls but I was
definitely trying to get Di's attention that something wicked this
way cometh. No such luck. They were eating banana boats cooked in
the fire and still completely engrossed in their puzzle game on the
picnic table.

It wasn't until the storm was
about five miles out and there was a blast of lightning bright
enough to capture their attention that the rest of our camping party
worked out it was time to batten down the hatches.

As I've told this story since, I
imagine the scene as the medical examiner investigated the scene of
the worst multiple lightning fatality on a campground in years. "I
just don't understand. What do you suppose was so damned important
on that picnic table? It's not like they didn't have lots of
warning."

The storms rolled in at 21h and
didn't roll out until after 03h. We contended with all manner of
storm-induced silliness including wind gusts strong enough to pull
the tent stakes up out of the ground. And we're talking about a
serious tent that has weathered some pretty ugly stuff over the
years. At some point Di and I had to go outside to pull down our
kitchen tarp lest its lines become fouled in those of our tent.

Emma and Sophie slept through it
all. Blissful ignorance of things that go flash and then boom in the
night.

Last week I roadtripped to
Bethany, West Virginia and ended up staying at the home of Larry and
Carol Grimes. Larry is the Chairman of the English Department at
Bethany College and was one of my treasured professors when I
attended Bethany many moons ago. I told the Grimes the story about
the camping and the lightning and the picnic table and ended the
conversation by saying that if I didn't experience another severe
thunderstorm for the rest of the season it would be all right by me.

You guessed it. At 01h I was
awakened by a bright flash and then stayed awake for more than an
hour as a powerful thunderstorm settled in over the town. It might
have been my imagination but the lightning flashes on the side of
the house closest to where I was sleeping seemed brighter and more
frequent.

Next stop on the roadtrip was
Winchester, Virginia. One evening we had dinner in Fairfax and were
driving back out to Winchester when we encountered an incredible
electrical storm. Blast after blast of sustained lightning
illuminated the sky and the interstate. You know that background hum
you feel more than hear when lightning chews up the ozone around you
just before the rush of deep thunder that sounds like it's coming up
from the ground instead of down through the air. And yet somehow we
drove through the heart of the storm without catching anything more
than a few drops of rain on the windshield. The thunderstorm's
presence was almost comforting and helped guide my way through the
unfamiliar territory.

I shouldn't be surprised nature
provided a backlight for the borrowed GPS system. I am, after all,
the lightning man.

HAL NEWMAN

Hal Newman is the
Executive Director of the National Emergency Management Resource Center.
NEMRC is the hub for an online community of practice that believes in a
fully-inclusive approach to emergency management taking into account all
population segments and helping to empower individuals and communities.
Newman is also part of the team at EAD & Associates LLC.

Newman’s three
decades of emergency services experience has served him well as a team
leader, policy advisor and catalyst. Newman is also the Managing Editor
of Big Medicine which is an online cooperative community sharing news,
views and resources related to emergency management and public health.
Newman works as part of the team at TEMS on social media strategy and
network acceleration.

Newman started his
career as a firefighter/street medic in Montreal West which led to an
emergency services visionquest with stops and opportunities to learn in
West Virginia, Maryland and finally back home in Montreal where he led a
small highly innovative EMS department. With that EMS organization,
Newman developed a number of special needs advocacy projects including
expanded scope of practice for community geriatric care; primary medical
support for homeless outreach care; and highrise evacuation protocols
for people with disabilities, the medically fragile, and the
vulnerable-at-the-moment.

Newman led a
team on behalf of the National Organization on Disability into
Mississippi immediately post-Hurricane Katrina to assess the
catastrophic impacts on people with special needs. That experience led
to a series of profound opportunities to provide assistance which
eventually resulted in his being presented the Dr. Martin Luther King,
Jr. Legacy Award for Humanitarian Service and the great privilege of
meeting Secretary of State Dr. Condoleezza Rice.

Newman blames his
insatiable curiosity about complex systems and network visualization on
being introduced to the works of Buckminster Fuller by the late futurist
Herman Kahn while Newman was still in his teens. Newman’s undergrad
studies were in Communications at BethanyCollege. His graduate studies
were in Emergency Health Services System Administration at the
University of Maryland at Baltimore County.

Hal Newman lives
near Montreal with his wife Dianne and their twin ten-year-old
daughters.